Brodalumab
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Precipitated adrenal crisis: case report A 55-year-old man had precipitation of adrenal crisis during treatment with brodalumab for psoriatic erythroderma. The man, who had been diagnosed with psoriatic erythroderma, initially received etretinate and ciclosporin 25 years prior to presentation. He further received unspecified topical steroids and several unspecified biologic agents since 2010, which partially improved the psoriasis. During biologic therapy, he was admitted to hospital three times due to dehydration with acute renal injury. Blood tests had showed reduced adrenocorticotropic hormone and plasma cortisol. He had signs of concurrent Cushing’s syndrome manifested as central obesity and abdominal skin striae and moon-face. A diagnosis of secondary adrenal insufficiency attributed to long-term use of unspecified topical steroids, which resulted in recurrent adrenal crisis was made. He started receiving treatment with oral steroid replacement to prevent adrenal crisis. He started receiving brodalumab [route and dosage not stated], which led to significant improvement in his psoriasis. Following the therapy, psoriasis remission was noted and unspecified topical steroids were further not required. After seven months of brodalumab therapy, unspecified oral steroids was discontinued. Afterwards, he had concurrent influenza infection and developed consciousness disorder and severe diarrhoea. He was transferred to hospital and on arrival, physical examination showed unmeasurable BP, SpO2 and hypothermia. A blood test revealed significantly elevated C-reactive protein, AST, ALT and creatinine with metabolic acidosis and electrolyte abnormalities. Echocardiography of the internal jugular vein was consistent with obvious collapse. He was diagnosed with multi-organ failure and shock secondary to adrenal crisis triggered by concurrent influenza virus infection. It was concluded that the adrenal insufficiency was attributed to unspecified steroids, which was unmasked following administration of unspecified biologic agents. Also, the abrupt withdrawal of unspecified oral steroids and brodalumab therapy precipitated adrenal crisis [duration of treatment to reaction onset not stated]. The man received treatment with unspecified systemic steroids and rapid rehydration. He recovered from shock and was discharged without any sequelae. Kuwatsuka S, et al. Bright side of biologics uncovered the dark side of long-term topical steroids: A psoriatic patient treated with biologics developed severe adrenal crisis. 803501569 Journal of Dermatology 47: e307-e308, No. 8, Aug 2020. Available from: URL: http://doi.org/10.1111/1346-8138.15419
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Reactions 19 Sep 2020 No. 1822
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