Abstract

Secukinumab, a fully human monoclonal antibody against IL-17A, is an effective treatment for psoriasis, psoriatic arthritis, and ankylosing spondylitis. The reported side effects include exacerbation of symptoms, emergence of inflammatory bowel disease, and very rarely Behçet’s syndrome. Behçet’s syndrome is a chronic, relapsing, multisystemic, autoimmune vasculitis that is characterized by mouth and genital ulcers, various skin lesions, and uveitis. Cardiovascular, musculoskeletal, gastrointestinal and neurological symptoms may also develop. Two months after starting Secukinumab therapy for psoriasis, a 39 year old female presented with vaginal ulcers, pustular lesions equally spread on both legs and oral ulcers. A biopsy of the pustular leg lesion revealed a dense neutrophilic infiltrate extending into the underlying subcutaneous tissue with a solitary collection of histiocytes, rare giant cells, and complete destruction of hair follicles. The diagnosis of Secukinumab induced psoriasis was favored over inflammatory bowel disease with aphthous ulcers because of the clinical features of multiple leg pustules, vaginal ulcers, absence of GI symptoms, and lack of prominent granulomatous inflammation in the thigh pustule biopsy. The Secukinumab was stopped and 10 mg/day prednisolone and certolizumab were started and her symptoms disappeared. To our knowledge, there are only two case reports of Behçet's syndrome after Secukinumab therapy. One patient had an exacerbation of Behçet’s syndrome, while the other developed de novo Behçet's syndrome after Secukinumab therapy for ankylosing spondylitis. This is the first reported case of Behçet’s syndrome developing de novo in a patient with psoriasis. Hopefully, this case report will alert clinicians to be aware of this rare side effect and know to effectively manage it.

Financial Disclosure:
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