title: Anti-TNF therapy in the treatment of psoriasis in a patient with acute-on-chronic pancreatitis.
abstract: BACKGROUND
  Psoriasis is accepted as a multisystemic disease with several important systemic manifestations. Thus, underlying comorbidities have to be taken into account in the choice of treatment.
  
  
  OBJECTIVE
  To explore the role of anti-TNF therapy in the treatment of psoriasis in a patient with acute-on-chronic pancreatitis.
  
  
  METHODS
  Here, we present the case of a 75-year-old patient with severe psoriasis also suffering from chronic alcohol-induced pancreatitis with recurrent acute flares. A recent life-threatening episode of acute pancreatitis and ischemic liver precluded the reintroduction of methotrexate. Cyclosporine was also excluded as it has been reported to induce acute pancreatitis. Thus, an anti-TNF treatment was initiated in close collaboration with a gastroenterologist.
  
  
  RESULTS
  A year after starting anti-TNF therapy the patient continues to show complete clinical remission of his psoriasis. No side effects, particularly no bacterial infections, were reported. No relapses of the patient's underlying chronic pancreatitis were observed throughout the entire treatment with regular clinical and laboratory monitoring, suggesting that chronic pancreatitis is not per se a contraindication for anti-TNF therapy.
  
  
  CONCLUSIONS
  This case study opens the way for further questioning on the role of TNF in the pathogenesis of chronic and acute pancreatitis and the use of anti-TNF therapy in its treatment.
authors.affiliation: Department of Dermatology, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: Helena
authors.initials: H
authors.lastname: Clayton
authors.forename: Lukas
authors.initials: L
authors.lastname: Flatz
authors.forename: Sonia
authors.initials: S
authors.lastname: Vollenweider-Roten
authors.forename: Alain
authors.initials: A
authors.lastname: Schoepfer
authors.forename: Michel
authors.initials: M
authors.lastname: Gilliet
authors.forename: Curdin
authors.initials: C
authors.lastname: Conrad
mesh_terms: D000208:Acute Disease; D000368:Aged; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D050500:Pancreatitis, Chronic / Q000150:complications*; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept