Secukinumab
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Staphylococcal toxic shock syndrome: case report A 6-year-old girl developed Staphylococcal toxic shock syndrome (STSS) during treatment with secukinumab for chronic plaque psoriasis. The girl presented with fever, vomiting and anuria. She had a significant history of chronic plaque psoriasis for which, she had been receiving secukinumab in the phase II trial, where she received SC injection of secukinumab 150mg. However, after 6 days of the second dose of secukinumab, she developed eroded plaques on the ankle, a morbilliform rash that expanded to generalised erythroderma, hypotension, tachycardia and somnolescence. Blood tests showed neutrophilia, leucocytosis, metabolic acidosis and coagulopathy. Her C-reactive protein was 130 mg/L and procalcitonin level was 2.54 ng/mL and culture studies from a conjunctival discharge revealed methicillin resistant S. aureus. Thus, a diagnosis of STSS was made. The girl was admitted and stabilised with norepinephrine and volume expansion therapy. Her secukinumab was stopped, and she was further treated with vancomycin, cefotaxime, clindamycin and immune globulin. Over a period of 5 days, her symptoms recovered and she was discharged on rifampicin and cefuroxime. At the time of discharge, a mild desquamation was noted. After 2 days, she presented with a new nodule on the right leg. Ultrasound testing showed a sub-cutaneous abscess. The abscess was drained and culture again grew methicillin resistant S. aureus. Subsequently, antibiotic treatment was switched to levofloxacin and rifampicin followed by cefuroxime and cotrimoxazole [trimethoprim/sulfamethoxazole]. By the day 30, complete resolution of the abscess was noted. Sanchez Martin M, et al. Staphylococcal toxic shock syndrome in a child with interleukin-17 inhibitor treatment for psoriasis. Pediatric Dermatology 37: 952-954, No. 5, SepOct 2020. Available from: URL: http://doi.org/10.1111/pde.14228 803515949
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Reactions 21 Nov 2020 No. 1831
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