摘要
Abstract
We report a case of pemphigus vulgaris induced by secukinumab treatment for plaque psoriasis.A 48-year-old man visited our department due to blisters on his lower extremities for over 2 months,and on the trunk and upper extremities for 7 days.He had a 6-year history of psoriasis.After 5 weeks of treatment with secukinumab,blisters appeared on the lower limbs,and after more than 3 months,blisters appeared on the trunk and upper limbs.Dermatological exami-nation revealed well-demarcated erythematous plaques with silvery scales on the scalp.The trunk and limbs exhibited multiple well-defined dark red patches with some silvery scales on the surface,scattered red papules,vesicles,and a positive Nikolsky's sign.The pathological examination of the scalp skin lesions showed epidermal hyperkeratosis and parakeratosis with irregular acanthosis,significant perivascular infiltration of lymphocytes and plasma cells in the dermis.The biopsy of the blister on the right forearm revealed hyperkeratosis,focal incomplete acantholysis of the epi-dermis,and perivascular inflammatory cell infiltration in the dermis.Direct immunofluorescence showed IgG and C3 deposition in a reticular pattern in the epidermis,while both IgA and IgM were negative.Diagnosis:psoriasis(scalp rash)and pemphigus vulgaris(rash of upper limbs).Secukinumab was discontinued,and 10 mg of methotrexate was given orally once weekly.After 6 months of treatments,the effect was inadequate,with new blisters still appearing.Therefore,it was switched to taking oral Cyclosporine soft capsules,50 mg,twice daily.After 1 month of treat-ment,the patient reported no new blisters and noted improvement in the existing psoriasis lesions on the scalp,trunk,and limbs.The patient is currently still under treatment and follow-up.关键词
斑块状银屑病/寻常型天疱疮/司库奇尤单抗Key words
plaque psoriasis/pemphigus vulgaris/secukinumab
