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CROHN’S-LIKE COLITIS INDUCED BY ANTI-IL-17 IXEKIZUMAB IN A PATIENT WITH REFRACTORY PSORIASIS: A CASE REPORT

Sofia Ponte 1, Daniela Gonçalves Ferreira 1, Sara Archer 1, Ana Teresa Ferreira 1, Cidalina Caetano 1, MARTA RODRIGUES 1, Paula Maria Vieira Santos 1, Isabel Pedroto 1

Affiliations

1 Centro Hospitalar Universitário de Santo António, Porto, Portugal

Summary

AI Generated

A 67-year-old woman with refractory psoriasis on Ixekizumab (anti-IL-17) developed severe inflammatory proctocolitis with features of Crohn's-like colitis, which resolved after discontinuing Ixekizumab and initiating Infliximab.

The patient presented with chronic abdominal pain, diarrhea (>10 bowel movements/day), rectal bleeding, anemia (9.9g/dL), and elevated C-reactive protein (181mg/L) while on Ixekizumab for psoriasis and arthritis refractory to methotrexate and ustekinumab.
Endoscopy revealed deep ulcers in the rectum and sigmoid; CT showed sigmoid colon and rectum wall thickening; histopathology showed chronic inflammation and excluded CMV infection, supporting Crohn's-like colitis possibly triggered by Ixekizumab.
Ixekizumab was discontinued and clinical remission was induced with Infliximab after corticosteroid failure; the patient achieved clinical remission and endoscopic response on Infliximab plus methotrexate.
The authors suggest this case indicates a possible association between anti-IL-17 therapies and de novo IBD onset, highlighting the need for surveillance of patients receiving these therapies.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

Psoriasis and Inflammatory Bowel Disease (IBD) overlap in epidemiology and immune mechanisms. Biologics have been used to treat both conditions. Interleukin-17 inhibitors (anti-IL-17) play a vital role in the approach of refractory psoriasis, but paradoxal gastrointestinal effects may occur.
A 67-year-old woman with chronic plaque psoriasis and arthritis refractory to methotrexate (MTX) and ustekinumab, at that moment under Ixekizumab (anti-IL-17), presented to the emergency room with chronic abdominal pain, diarrhea (>10 bowel movements/day) and rectal bleeding. Blood workup showed normocytic normochromic anemia (9,9g/dL) and elevated C-reactive protein (181mg/L). Clostridioides difficile toxin test and stool cultures were negative. Computed tomography showed sigmoid colon and rectum wall thickening and densification of the surrounding fat. Endoscopy revealed deep ulcers in the rectum and sigmoid.
The main diagnostic hypothesis were severe inflammatory proctocolitis triggered by anti-IL-17 and infectious colitis (including cytomegalovirus (CMV) infection). Clinical, endoscopic and histopathologic findings supported a Crohn’s-like colitis possibly triggered by Ixekizumab. Histopathology revealed chronic inflammation and excluded CMV infection.
Ixekizumab was discontinued; clinical remission was induced with Infliximab (IFX), after corticosteroid (CT) failure. Six weeks later, she was admitted with cellulitis. CT was rapidly tapered. Due to her medical background as well as clinical, biologic and endoscopic improvement, after a multidisciplinary discussion, it was decided to maintain IFX in association with MTX. Further follow-up revealed clinical remission and endoscopic response.
The increasing use of anti-IL-17 in psoriatic patients led to the report of rare cases of IBD onset in this population. This case suggests a possible association between anti-IL-17 therapies and de novo IBD, highlighting the need of surveillance of patients under these therapies.

References

Endoscopic images (total of 4 pictures); photographs of lower limbs (total of 5 pictures).

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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