Abstract:

The patient, a 16-year-old boy, presented with a 9-year history of periungual erythema and pustules of the right hand as well as one year history of interphalangeal abnormality of the fourth and fifth finger of the right hand. Cutaneous examination revealed diffuse erythema and scattered or dense pustules on the dorsal and palmar aspects of right hand as well as on the first, forth and fifth fingers. Some pustules formed pus lakes or pus scabs. Onychoptosis of the involved fingers with tapering of the distal phalanges was observed. The interphalangeal abnormality of the fourth and fifth finger induced functional limitation. A small amount of infiltrated erythema scattered on the extremities with few pustules on the surface. The patient had no personal or family history of psoriasis. Laboratory examination was in the range of normal reference values, including complete blood count, urinalysis, liver function test, hepatitis B and C serology, antinuclear antibody , anti-dsDNA antibody, and AIDS antibody et al. Purified protein derivative (PPD) of tuberculin test was negative. There were no abnormality in chest X-ray and electrocardiogram examination. The diagnosis of generalized acrodermatitis continua was made. The patient was treated with acitretin capsules, huo ba hua gen tablets, compound glycyrrhizin injection in combination with mometasone furoate cream, mupirocin ointment, and calcipotriol/betamethasone ointment. After 2 weeks of treatment, cutaneous lesions partially subsided, a few of new pustule formed occasionally, and pains of the involved fingers alleviated, but the patients’ disease remained to progress, the second finger of the right hand and the fifth finger of the left hand was also involved. In order to prevent the further development of the disease, then decided to start recombinant human tumor necrosis factor receptor Ⅱ:Fc fusion protein(rhTNFR:Fc, with a trade name of Yisaipu) treatment after weighing the benefit-risk carefully. After 12 weeks of treatment, skin lesions on the extremities subsided, the formation of new pustules stopped, but the finger deformity and function did not improve.

Key words: rhTNFR: Fc