case_images: PMC11830582_01
case_images: Clinical manifestations of adverse drug events caused by combination therapy with adalimumab, sulfasalazine, and etoricoxib for ankylosing spondylitis. (A) Strawberry tongue; (B) Small red maculae and maculopapular scattering on the neck; (C) Swollen and red strawberry tongue with visible teeth marks on the edge; (D) Erythema and erosion in umbilical region; (E,F) Dispersed papules/macules and desquamation in armpit and on upper arm; (G) Generalized scalp erythema, exudates, scabs, hair bundles, redness and desquamation behind ears; (H) Scalp pustules, desquamation, and fissures, in addition to dryness and desquamation around ear.
case_images: fmed-12-1419922-g001.jpg
case_images: PMC11830582_01_fmed-12-1419922-g001.jpg
case_images: F1
case_images: Decreased saliva, dry lips, tongue numbness, and loss of taste appeared in June 2019; blisters occurred on the dorsum of swollen tongue in July 2019 (Figure 1). His tongue became painful and more swollen, and small red maculae and maculopapular scattered around his upper trunk 5 days before the visit (Figure 1). On examination, dry lips, swollen and red strawberry tongue with visible teeth marks on the edge were noticed (Figure 1); submandibular and cervical lymph nodes were enlarged but non-tender to palpation. During our first follow-up in November 2019, the superficial blisters on his tongue shrank or vanished, along with improvement in taste; however, recurrent dispersed papules/macules and desquamation appeared on/in his face and bilateral armpits/upper arms, accompanied by erythema and erosion in umbilical region (Figure 1). In February 2020, the patient consulted us again for generalized scalp erythema, exudates, scabs, hair bundles, redness and desquamation behind ears without pain/fever in recently 2 weeks, although the tongue and taste mostly recovered and the rashes in/on bilateral armpits/upper arms generally disappeared (Figure 1). In March 2020, the scalp exudates decreased, but there were still pustules, scalp desquamation and fissures, in addition to dryness and desquamation around his ears (Figure 1).
case_images: Disease progression after simultaneous use of adalimumab, sulfasalazine, and etoricoxib for ankylosing spondylitis.
case_images: fmed-12-1419922-g002.jpg
case_images: PMC11830582_01_fmed-12-1419922-g002.jpg
case_images: F2
case_images: The total course of disease was nearly 10 months (Figure 2).