Reactions 1704, p266 - 2 Jun 2018 Various toxicities: case report A 53-year-old woman developed severe palmoplantar pustulosis and generalised guttate psoriasis during treatment with adalimumab and infliximab, pustular eruption at injection site during treatment with anakinra, and urticarial and morbilliform eruptions during treatment with thalidomide [route, dosage and time to reaction onsets not stated]. The woman was diagnosed with mixed genital hidradenitis suppurativa and vulval pyoderma gangrenosum. Her treatment was started with unspecified oral and IV pulse corticosteroids. Improvement was noted in her condition. However, she developed steroid induced vertebral and hip fractures despite receiving bone prophylaxis that required multiple vertebroplasties. Thereafter, she was trialled on various therapies including various unspecified antibiotics, spironolactone, cyproterone [cyproterone acetate], colchicine, zinc, ciclosporin, mycophenolate mofetil, azathioprine, methotrexate and immune-globulin, but no improvement was noted or the therapies resulted in unspecified adverse effects. Additionally, trials with infliximab and adalimumab led to the development of severe palmoplantar pustulosis and generalised guttate psoriasis; trial with anakinra led to the development of pustular eruption at injection site, and trial with thalidomide led to the development of urticarial and morbilliform eruptions. Re-challenge with thalidomide also resulted in the same reactions. Later, her treatment was started with ustekinumab, dapsone, metronidazole and ciprofloxacin [outcomes not stated]. Author comment: "Multiple other therapeutics modalities have been trialled without success (or adverse effect), including. . .infliximab (improvement noted but as with adalimumab, was complicated by severe palmoplantar pustulosis and generalised guttate psoriasis) and anakinra (complicated by pustular eruption at injection site and no clinical effect after 28 days). Thalidomide was complicated by urticarial and morbilliform eruption, even on rechallenge." Nguyen Y, et al. A complex case of vulval pyoderma gangrenosum. Australasian Journal of Dermatology 59 (Suppl. 1): 4-5, May 2018. Available from: URL: http:/ /doi.org/10.1111/ajd.2_12815 [abstract] - Australia 803323439 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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