Etanercept
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Paradoxical induction of Crohn’s disease: case report A 37-year-old man exhibited paradoxical induction of Crohn’s disease (CD) during treatment with etanercept for psoriatic arthritis. The man, who had cutaneous psoriatic arthritis for the past 20 years, started receiving etanercept 50mg weekly [route not stated]. About five months later, he presented with watery diarrhoea along with mild hematochezia since last 4 months and moderate to severe left upper quadrant pain radiating to the peri-umbilical area since 2 months. Additionally, an unintentional weight loss of 24 pounds was reported over the period of 5 months following initiating etanercept. Subsequent physical examination revealed erythematous annular scaly plaques present on both his elbows and knees, diffuse abdominal tenderness to palpation and mild joint deformities. The complete blood count was unremarkable; however, Creactive protein was found to be elevated to 25 mg/dL. The stool culture and PCR test was negative. Subsequent colonoscopy revealed active colitis along with multiple distinct colonic ulcers with loss of vascular pattern and friable mucosa present predominately in the left, right and sigmoidal colon segments. Pathology results also confirmed active colitis with significant ulceration along with non-caseating granulomas which were indicative of CD. Based on IgA and IgG antibody testing for saccharomyces cerevisiae, he was diagnosed with paradoxical induction of CD secondary to treatment of psoriatic arthritis with etanercept [duration of treatment to reaction onset not stated]. The man’s etanercept was therefore switched to ustekinumab. Following four weeks of ustekinumab therapy, his psoriatic arthritis and new onset CD were noted to be in remission. Author comment: "[I]n predisposed patients, treatment with etanercept may alter the inflammatory cytokine environment, promoting the development of [Crohn’sdisease]." "Lastly, ustekinumab was successful in relieving our patient’s cutaneous, joint and gastrointestinal symptoms and may be considered an effective treatment option in patients suffering from both psoriasis and CD or the paradoxical induction of one disease entity secondary to treatment of the other." Forouzandeh M, et al. The Paradoxical Induction of Crohn’s Disease Following Treatment of Psoriatic Arthritis With Etanercept. Journal of Drugs in Dermatology 18: 832-834, No. 8, Aug 2019. Available from: URL: https://jddonline.com/ 803440605 articles/dermatology/S1545961619P0832X/1/ - USA
0114-9954/19/1784-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 21 Dec 2019 No. 1784
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