Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2021; 9(15): 3655-3661
Published online May 26, 2021. doi: 10.12998/wjcc.v9.i15.3655
Recalcitrant paradoxical pustular psoriasis induced by infliximab: Two case reports
Ping Xia, Yan-Hong Li, Zhong Liu, Xu Zhang, Qian Jiang, Xiao-Yong Zhou, Wei Su
Ping Xia, Yan-Hong Li, Zhong Liu, Xu Zhang, Qian Jiang, Xiao-Yong Zhou, Department of Dermatology, The First Hospital of Wuhan, Wuhan 430022, Hubei Province, China
Wei Su, Department of Dermatology, Midwest Center for Dermatology and Cosmetic Surgery, Clinton Township, MI 48038, United States
Author contributions: Xia P performed the literature search, clinical studies and wrote the manuscript; Li YH, Liu Z, Zhang X, and Jiang Q did laboratory tests and data analysis; Zhou XY contributed the concept, design, and manuscript editing; Su W reviewed and edited the manuscript; All authors have read and approve the final manuscript.
Supported by the Ministry of Science and Technology of China, No. 2018YFC1705304 and Hubei Natural Science Foundation, No. 2020CFB503.
Informed consent statement: All participants provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yong Zhou, MD, Doctor, Department of Dermatology, The First Hospital of Wuhan, No. 215 Zhongshan Avenue, Wuhan 430022, Hubei Province, China. zhouxuefeng1970@126.com
Received: November 4, 2020
Peer-review started: November 4, 2020
First decision: February 12, 2021
Revised: February 25, 2021
Accepted: March 12, 2021
Article in press: March 12, 2021
Published online: May 26, 2021
Abstract
BACKGROUND

Paradoxical psoriasis induced by tumor necrosis factor alpha antagonists is a rare side effect of those drugs and has similarities with and differences from classical psoriasis in clinical and pathological characteristics. Treating severe paradoxical psoriasis is challenging because the reported cases are rare, with treatment experience being only anecdotal.

CASE SUMMARY

We report 2 cases of paradoxical psoriasis caused by infliximab. Both cases manifested with a significant number of pustular lesions and had protracted and complicated clinical courses. In case 1, secukinumab alone could not control the eruptions, but colchicine supplementation markedly decreased disease activity. In case 2 miscellaneous medications were administered, including the systemic drug acitretin, the immunosuppressive drug cyclosporine, and the biologic agent ustekinumab. However, multiple applications of those medications failed to prevent new lesions from occurring. Both cases showed moderate-to-high anti-nuclear antibody titers.

CONCLUSION

Based on these cases, moderate-to-high anti-nuclear antibody titer seems to be a risk factor for paradoxical psoriasis. In addition, extensive pustular presentation may be a negative prognostic indicator and may portend a protracted clinical course refractory to therapy.

Keywords: Pustular psoriasis, Paradoxical, Infliximab, Secukinumab, Ustekinumab, Anti-nuclear antibody, Case report

Core Tip: In this study, we report 2 cases of paradoxical psoriasis caused by infliximab. The data indicated that moderate-to-high anti-nuclear antibody titer was a risk factor for paradoxical psoriasis. In addition, extensive pustular presentation might be a negative prognostic indicator and portends a protracted clinical course refractory to therapy.