Case Report: Tocilizumab as time-limited induction therapy enabling steroid withdrawal and conventional maintenance in refractory cutaneous polyarteritis nodosa

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Abstract
Background: Cutaneous polyarteritis nodosa (CPAN) is a chronic, relapsing vasculitis frequently associated with glucocorticoid dependence and the absence of standardized treatment algorithms. Therapeutic decisions are largely empirical and management of refractory disease remains challenging. Case presentation: We report a patient with refractory CPAN and persistent steroid dependence despite corticosteroids and conventional immunosuppressive therapies. A deliberately planned, time-limited induction strategy with tocilizumab (TCZ) was implemented to achieve rapid disease control and enable steroid withdrawal, followed by maintenance with mycophenolate mofetil (MMF). Results: TCZ led to rapid clinical remission after two infusions, allowing progressive steroid tapering and discontinuation. After six doses, TCZ was stopped and MMF was introduced as maintenance therapy. The patient remains lesion-free at the time of manuscript submission. Conclusion: A time-limited IL-6 blockade strategy may allow rapid steroid withdrawal and facilitate transition to conventional maintenance in refractory CPAN. This approach may reduce cumulative exposure to both glucocorticoids and biologic agents.

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