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Letter
IL-17A inhibitor-induced leucocytoclastic vasculitis is responsive to IL-23 blockade in a psoriatic arthritis patient
  1. KC Binod1,
  2. Austin Jabbour2,
  3. Pooja Poudel1,
  4. Katalin Banki3,
  5. Andras Perl4
  1. 1 SUNY Upstate Medical University, Syracuse, New York, USA
  2. 2 SUNY Upstate Medical University Hospital, Syracuse, New York, USA
  3. 3 Pathology, SUNY Upstate Medical University Norton College of Medicine, Syracuse, New York, USA
  4. 4 Medicine, SUNY Upstate Medical University Norton College of Medicine, Syracuse, New York, USA
  1. Correspondence to Dr Andras Perl, Medicine, SUNY Upstate Medical University Norton College of Medicine, Syracuse, NY 13210, USA; PERLA{at}upstate.edu

https://doi.org/10.1136/ard-2023-224604

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    Introduction

    Secukinumab is a fully humanised monoclonal antibody directed at interleukin 17A (IL-17A) which has been widely used for the treatment of plaque psoriasis, psoriatic arthritis (PsA) and ankylosing spondylitis.1 The use of secukinumab increases the risk of mucocutaneous candidiasis, but little is known about other specific cutaneous adverse events (AEs). Of note, few cases of secukinumab-induced leucocytoclastic vasculitis (LCV) have been described in the literature.2 3

    Case presentation

    A 59-year-old man with a history of plaque psoriasis and PsA refractory to first-line and second-line treatment presented with worsening disease. To manage the PsA of this patient, first-line therapy included non-steroidal anti-inflammatory drugs, such as ibuprofen and methotrexate, as a non-biological disease-modifying antirheumatic drug, while the tumour necrosis factor inhibitor infliximab was used as a second-line therapy. The treatment with infliximab had controlled his disease burden for 8 years until the development of biopsy-proven LCV. Infliximab was discontinued, and adjunct therapy with methylprednisolone and antihistamines led to complete resolution of LCV.

    Several months after resolution, he was started on secukinumab 300 mg subcutaneously every 4 weeks for recurrent psoriasis and PsA. Following 2 years of maintenance therapy with good disease control, he developed acute-onset skin lesions of the bilateral lower extremities. Physical examination was significant for scattered palpable purpura from 0.3 to 2.0 cm of the bilateral lower extremities, most notably circumferentially around the ankles (figure 1A). There was no evidence of active PsA, and body surface area of psoriasis was <1% at that time. These lesions lasted until secukinumab was discontinued and alternative therapies were instituted (figure 1B …

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    Footnotes

    • Handling editor Josef S Smolen

    • Contributors All authors contributed to the writing of the manuscript.

    • Funding This work was supported in part by grants AI072648, AI122176 and AR076092 from the National Institutes of Health, the Phillips Lupus and Autoimmunity Center of Excellence and the Central New York Community Foundation.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.