IgA nephropathy in a patient receiving infliximab for generalized pustular psoriasis
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CASE REPORT
Open Access
IgA nephropathy in a patient receiving infliximab for generalized pustular psoriasis Yuka Segawa1, Ryo Ishida1, Fuminao Kanehisa2, Kunihiro Nakai1, Mari Morimoto2, Masafumi Seno1, Mayuka Nakayama1, Tetsuro Kusaba1, Norito Katoh2 and Keiichi Tamagaki1*
Abstract Background: IgA nephropathy is the most common glomerulonephritis. Secondary IgA nephropathy complicated with systemic diseases, including psoriasis, is also often reported. Generalized pustular psoriasis is a form of psoriasis characterized by sterile pustules on reddened skin and fever. Infliximab, one of the first-line therapies for severe psoriasis, has also been reported to cause systemic vasculitis and IgA nephropathy. We herein report a case of IgA nephropathy activated during infliximab treatment for generalized pustular psoriasis. Case presentation: A 28-year-old woman presented with episodic gross hematuria, increasing proteinuria, and renal dysfunction. She had been receiving anti-TNFα therapy with infliximab because of generalized pustular psoriasis for 3 years, but her skin symptoms worsened following withdrawal during pregnancy. After delivery, her skin symptoms improved with the resumption of infliximab, but clinical signs suggested glomerulonephritis, and renal biopsy showed active IgA nephropathy. Infliximab was discontinued, and the combination of corticosteroids, tonsillectomy, and secukinumab, an IL-17A inhibitor, improved both the skin symptoms and the glomerulonephritis. Conclusions: In our case, the activity of IgA nephropathy was exacerbated by anti-TNFα therapy but was improved by the combination of corticosteroids, tonsillectomy, and an IL-17A inhibitor against the original disease. Autoimmune diseases may underlie the development of secondary IgA nephropathy associated with anti-TNFα therapy, and so further studies are needed to better understand the association between molecular-targeted drugs and IgA nephropathy. Keywords: IgA nephropathy, Generalized pustular psoriasis, Infliximab, TNFα, Secukinumab, IL-17
Background IgA nephropathy (IgAN) is the most common glomerulonephritis. It manifests a variety of clinical courses, often shows persistent hematuria, and sometimes shows macroscopic hematuria associated with mucosal infections. IgAN is an autoimmune disorder in which IgA1IgG immune complexes deposit on the mesangium and cause inflammation. The immunogenicity of IgA1 is due to an IgA1 galactosylation defect [1]. Secondary IgAN complicated with systemic diseases, such as liver * Correspondence: [email protected] 1 Division of Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan Full list of author information is available at the end of the article
cirrhosis, rheumatoid arthritis, inflammatory bowel disease, and other autoimmune diseases, is also often reported [2]. Generalized pustular psoriasis (GPP) is a form of psoriasis characterized by the presence of sterile pustules on reddened skin covering almost the entire bod
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