Successful response in a case of severe pustular psoriasis after interleukin-1β inhibition.
Generalized pustular psoriasis (GPP) is a severe type of psoriasis accompanied by systemic and often life-threatening manifestations. The efficacy of the interleukin (IL)-1 antagonist anakinra in cases of GPP underscores the role of IL-1 in disease pathogenesis. We present a case of a middle-aged man who developed an abrupt and severe form of GPP with severe eosinophilia and cholestatic hepatitis. The patient received salvage treatment with a combination of glucocorticoids, hydroxyurea and imatinib, while administration of the IL-1 inhibitor anakinra resulted in remission of hepatitis and a significant skin improvement. However, due to persistent hypersensitivity skin reactions, anakinra was withdrawn and replaced with the anti-IL-1β antagonist canakinumab. As a result of canakinumab, the patient's skin completely cleared, while no systemic manifestations recurred. After 1 year of continuous canakinumab therapy, the patient remained virtually free of symptoms, while the drug was well tolerated.
First Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, 68100, Greece.
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Skendros
First Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, 68100, Greece.
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Papagoras
State Clinic of Dermatology, Hospital for Skin and Venereal Diseases, Thessaloniki, Greece.
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Lefaki
Department of Pathology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, 68100, Greece.
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Giatromanolaki
Department of Haematology, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, 68100, Greece.
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Kotsianidis
Department of Immunology and Histocompatibility, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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Speletas
UF d'Histocompatibilité et Immunogénétique, Département d'Immunologie, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Paris, France.
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Bocly
UF d'Histocompatibilité et Immunogénétique, Département d'Immunologie, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Paris, France.
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Theodorou
First Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, 68100, Greece.
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Dalla
First Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis, 68100, Greece.
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Ritis
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents / Q000627:therapeutic use*; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D053583:Interleukin-1beta / Q000037:antagonists & inhibitors*; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000139:chemically induced / Q000188:drug therapy*; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D053590:Interleukin 1 Receptor Antagonist Protein; D053583:Interleukin-1beta; C541220:canakinumab