The risk of herpes zoster in the anti-TNF-α era: a case report and review of the literature.

Background: Tumor necrosis factor-α (TNF-α) inhibitors represent efficacious the-rapeutic agents in many chronic inflammatory diseases such as psoriasis and rheu-matoid arthritis. However they have been connected with increased risk of infection and reactivation of a variety of infectious agents, such as viruses. The reactivation of varicella zoster virus infection causes herpes zoster (HZ), a self-limiting, dermato-mally localized, vesicular rash that can be accompanied by postherpetic neuralgia and severe neurological complications. Main observations: Limited information has been published regarding HZ during therapy with TNF-α inhibitors especially for the occurrence of HZ during adalimu-mab treatment. We report the case of a 58-year-old immunocompetent man with a 18-year history of plaque psoriasis who develops ophthalmic HZ during treatment with adalimumab. Conclusion: We report this case to enrich the literature and to highlight the incre-ased risk of HZ infections in patient on anti-TNF-α therapy (incidence of HZ is about 3-fold increased respect to general population). Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. Therefore, it is very im-portant to identify early signs and symptoms of herpes zoster in patients on biologic therapy in order to start prompt efficient antiviral treatment to prevent the develop-ment of severe complications.