Takayasu's arteritis occurring under TNF-α blockers: a new paradoxical effect?

Takayasu's arteritis (TA) is a rare granulomatous vasculitic disease. Recently, experimental studies and several case reports have supported the use of anti-tumour necrosis factor (TNF) therapy for severe forms of TA. We report a case of a 58-year-old woman who was followed for spondyloarthritis. Her disease was resistant to non-steroidal anti-inflammatory drugs, and TNF-α blockers were initiated. The patient developed asthaenia and severe back pain. The erythrocyte sedimentation rate was 82 mm and C reactive protein was 192 mg/L. Based on thickened walls of large vessel on MRI, a diagnosis of TA was established. Under corticosteroids and after discontinuation of TNF-α blockers, the patient remained free of symptoms at 8-month follow-up.