IgA vasculitis during secukinumab therapy
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CASE BASED REVIEW
IgA vasculitis during secukinumab therapy Dijana Perkovic 1 & Petra Simac 1 & Josip Katic 2 Received: 30 June 2020 / Revised: 20 August 2020 / Accepted: 24 August 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Psoriatic arthritis is a chronic, seronegative spondyloarthropathy associated with psoriasis, depending on patient presentation treatment options range from non-pharmacologic measures to NSAIDs, DMARDs, and biologics. Secukinumab is a human monoclonal antibody that specifically targets interleukin-17 and has been shown to be highly effective in the treatment of psoriatic arthritis. As the use of IL-17 inhibitors has been approved in the treatment of psoriatic arthritis, clinicians need to be aware of unusual adverse events not previously observed in clinical trials. We report a rare case of Henoch-Schönlein purpura vasculitis induced by secukinumab in a 39-year-old patient. Therefore, using biologic drugs in clinical practice should be aware that cutaneous vasculitis may be triggered by anti-IL17 treatment, and early diagnosis always helps to decrease morbidity and reduce the amount of time to recovery as well as the impact on the quality of life disruption. Keywords Biologics . Henoch-Schönlein purpura . IL-17 . Psoriatic arthritis . Rheumatology . Secukinumab
Introduction
Case report
Secukinumab is an entirely human monoclonal antibody that specifically targets interleukin (IL)-17A, thereby blocking its binding with the IL-17 receptor (IL17-R). Consequently, the downstream cascade of IL-17-associated cytokines is decreased. This blockade normalizes the inflammatory processes and thus has a negative effect on the epidermal hyperproliferation, T cell infiltration, and excessive expression of pathogenic genes [1]. Secukinumab is indicated for the treatment of plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis [2]. Although it has a favorable safety profile, many adverse effects have been reported. However, so far, no case of immunoglobulin A vasculitis (IgAV) caused by the use of secukinumab has been described in the literature [3–5]. The aim of this paper is to describe a case report of a patient who developed IgAV, formerly called Henoch-Schönlein purpura (HSP) while being treated by secukinumab.
A 39-year-old woman has been treated for HLA B27-positive PsA since 1998. During her course of illness, she has been treated with various medications: sulphasalazine, methotrexate (MTX), infliximab, and golimumab. From January of 2017, treatment with secukinumab was introduced with a positive therapeutic response. Two months after the beginning of treatment with secukinumab, her Psoriasis Area Severity Index (PASI) score was 0. In July of 2018, the patient developed palpable purpura on the skin of lower limbs (Fig. 1). It is important to note that the psoriatic skin lesions were stationary and the arthritis was not active. Pathophysiological analysis (PHD) of the skin was consistent with leukocytoclastic vasculitis (LCV) (Fig. 2). Initia
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