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Treatment failure, carcinoid syndrome and carcinoid tumour: case report A 32-year-old woman exhibited failure of treatment with sulfasalazine for psoriatic arthritis. Later, she developed carcinoid syndrome and carcinoid tumour during treatment with etanercept for psoriatic arthritis, and she exhibited ineffectiveness during treatment with leflunomide and ustekinumab for psoriatic arthritis [routes and dosages not stated]. The woman, who had a history of acne rosacea, was diagnosed with psoriatic arthritis at the age of 32 years in 2000. Initially, she started receiving sulfasalazine, which failed. Subsequently, sulfasalazine was stopped, and the woman started receiving methotrexate; however, the arthritis flared in 2011. Therefore, she additionally started receiving etanercept, which proved effective. Following 4 years of treatment with etanercept and methotrexate, liver profile was noted to be deranged. Etanercept was stopped, and investigations were performed while she was off treatment. An ultrasound of the abdomen showed a liver mass, which resembled with a focal nodular hyperplasia on an MRI. Further tests revealed high level of urinary 5HIAA (527 µmoL/24h) along with raised levels of chromogranin-A (1574 pmol/L) and chromogranin-B (373 pmol/L). She did not have any symptoms that suggested of carcinoid; however, it was noted that facial flushing might have been camouflaged by the rosacea. An octreotide scan was positive, and a CT enterogram revealed a distal ileal neuroendocrine tumour along with adjacent lymphadenopathy. She developed carcinoid syndrome and carcinoid tumour secondary to etanercept. She therefore underwent right hemihepatectomy and hemicolectomy. She had been receiving methotrexate, and the liver profile deteriorated again. Therefore, she received leflunomide, which was ineffective. In November 2017, she started receiving ustekinumab, which was also ineffective. Ustekinumab was therefore stopped after 8 months. No alterations in the carcinoid blood markers were observed, and there were no changes on a CT scan. She had been receiving unspecified steroids. In July 2018, she started receiving secukinumab, which led to reduction in steroids. At the time of report (after >1 year of secukinumab therapy), no adverse effects were observed. Also, no progressive CT changes were noted. Regular surveillance did not reveal any recurrence of the carcinoid, with serial negative chromogranin and 5HIAA levels. Sheikh ASF, et al. Carcinoid syndrome on etanercept and subsequent treatment with secukinumab in a patient with psoriatic arthritis. Rheumatology 59 (Suppl. 2): ii39 abstr. 803507406 P55, Apr 2020. Available from: URL: http://doi.org/10.1093/rheumatology/keaa111.054 [abstract]

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Reactions 17 Oct 2020 No. 1826