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Adalimumab/vedolizumab Thoracoabdominal herpes-zoster infection, vulgar psoriasis and paradoxical psoriasis: case report

An adult woman [exact age at reactions onsets not stated] developed a thoracoabdominal herpes-zoster infection and vulgar psoriasis during treatment with adalimumab. At the age of 34 years, she developed severe paradoxical psoriasis during treatment with vedolizumab for Crohn’s disease. The woman, who had been diagnosed with A2L1B3 Crohn’s disease in 2005, had been treated with adalimumab [dosage and route not stated] in 2011. Adalimumab was discontinued 6 months later due to a thoracoabdominal herpes-zoster infection. Two months after adalimumab reintroduction, she showed an extensive and exudative scalp lesion that were herpes-zoster-PCR negative. Adalimumab was discontinued and topical-steroids [specific drug not stated] were started, with a further worsening of exudative lesions that affected the entire occipital area with thick psoriasiform scales and a biopsy compatible with vulgar psoriasis. She received treatment with methotrexate. The treatment with methotrexate led to a complete resolution of the skin lesions and remission in the Crohn’s disease. Due to pregnancy planning, methotrexate was stopped in June 2017. Eight months later, systemic steroid-therapy [specific drug not stated] was introduced due to a moderate/severe intestinal flare and infusion of vedolizumab 300mg 8/8 weeks [sic] was initiated in March 2018. After the second infusion with ongoing steroid tapering, she reported only mild hair loss. She achieved clinical remission in January 2019 without steroids and vedolizumab was continued. In March 2019 (i.e. at the age of 34 years), she reported the reappearance of extensive scalp and peri-fistula psoriatic lesions. The woman received topical therapy [specific drug not stated] which was unsuccessful due to the progressive worsening of disabling lesions. Vedolizumab was suspended. The lesions improved one month after vedolizumab termination. Guedes TP, et al. Vedolizumab-associated psoriasis: Until where does gut selectivity go?. Revista Espanola de Enfermedades Digestivas 112: 580-581, No. 7, Jul 2020. 803499560 Available from: URL: http://doi.org/10.17235/reed.2020.6817/2019

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Reactions 5 Sep 2020 No. 1820