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Worsening of plaque psoriasis, thrombocytopenia, congestive heart failure and sepsis: 3 case reports Three patients with chronic plaque psoriasis developed worsening plaque psoriasis (patients 1 and 3), thrombocytopenia (patient 2) and/or congestive heart failure and sepsis (patient 3) during treatment with etanercept and infliximab (patient 1), etanercept (patient 2) or infliximab (patient 3). Subsequently, all patients were successfully treated for psoriasis with alefacept. Patient 1, a 56-year-old woman, experienced worsening psoriasis following a 6-month course of etanercept [dosage and time to reaction onset not stated] and was enrolled in an infliximab evaluation trial. However, during infliximab administration [dosage not stated], her condition continued to worsen with a body surface area (BSA) involvement of 50% [baseline 12%; time to reaction onset not stated]. She was discontinued from the trial and subsequently received alefacept and her disease BSA involvement decreased to 2%. Patient 2, a 37-year-old man, received a 3-month course of etanercept with a dramatic improvement in disease BSA [dosage not stated]. However, he developed thrombocytopenia (88 000 /µL) [time to reaction onset not stated] and etanercept was discontinued. Subsequently, etanercept was reinitiated [dosage not stated], which caused a recurrence of thrombocytopenia [duration of therapy to reaction onset not stated]. Following discontinuation, he experienced a relapse of psoriasis and received alefacept. Subsequently, his disease BSA decreased to 0%. Patient 3, a 47-year-old man, who had previously received etanercept and adalimumab without improvement, started receiving IV infliximab 5 mg/kg [frequency not stated]. Within 2 months, he was hospitalised with congestive heart failure and sepsis. After 2 months, he presented with a disease BSA of 70%. He received alefacept and his disease BSA decreased to 25%. Hamilton T. Successful treatment of psoriasis with alefacept in patients with previous adverse reactions to anti-TNF-alpha treatments: three case studies. Journal of the American Academy of Dermatology 58 (Suppl.): AB133 (plus poster) abstr. 801100340 P2673, No. 2, Feb 2008 [abstract] - USA

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Reactions 16 Feb 2008 No. 1189