We read with interest the report by Soliotis et al1 of erythema multiforme (EM) occurring with etanercept. Here we report a case of EM with another tumour necrosis factor (TNF) inhibitor, infliximab, which has not recurred on switching to etanercept.

One week following his third infliximab infusion, a 59-year-old man who had had ankylosing spondylitis for 6 years presented with purpuric rash over the lower legs and blistering. Other medications were telmisartan hydrochlorothiazide and fluticasone/salmeterol inhaler. A skin punch biopsy demonstrated lichenoid inflammatory reaction with focal epidermal necrosis. The rash was presumed an allergic reaction to infliximab, and promethazine and hydrocortisone premedication was …