Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report
A 35-year-old man with a late-onset combined immunodeficiency (LOCID) variant of common variable immunodeficiency, severe plaque psoriasis, psoriatic arthritis, and Crohn’s disease was attended in the Regional Hospital of Presidente Prudente and HC-FMUSP, São Paulo, Brazil. Anti-IL-12/IL-23 (ustekin...
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MDPI AG
2023-09-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/12/9/1156 |
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| author | Luiz Euribel Prestes-Carneiro Marilda Aparecida Milanez Morgado de Abreu Eduardo Vinicius Mendes Roncada Diego Garcia Muchon Fernanda Miranda Caliani Dewton Moraes Vasconcelos |
| author_facet | Luiz Euribel Prestes-Carneiro Marilda Aparecida Milanez Morgado de Abreu Eduardo Vinicius Mendes Roncada Diego Garcia Muchon Fernanda Miranda Caliani Dewton Moraes Vasconcelos |
| author_sort | Luiz Euribel Prestes-Carneiro |
| collection | DOAJ |
| description | A 35-year-old man with a late-onset combined immunodeficiency (LOCID) variant of common variable immunodeficiency, severe plaque psoriasis, psoriatic arthritis, and Crohn’s disease was attended in the Regional Hospital of Presidente Prudente and HC-FMUSP, São Paulo, Brazil. Anti-IL-12/IL-23 (ustekinumab) monoclonal antibody was prescribed due to the failure of other treatments (phototherapy, oral acitretin) for psoriasis and a Psoriasis Area Severity Index >10. We evaluated the impact of treatment with ustekinumab on severe infectious diseases in a patient with uncontrolled psoriasis and LOCID followed for 8 years. Four quarterly doses of ustekinumab 90 mg and human immunoglobulin replacement (10,000 mg at 28-day intervals) were administered. Immunophenotyping, cultures of lymphocytes, genetic sequencing, and whole exome sequencing were performed to investigate the primary immunodeficiency. Normal lymphocyte proliferation; pathogenic variants in genetic sequencing, and clinically significant variants in the whole exome for primary immunodeficiencies were not detected. The main infections before and after treatment with ustekinumab were chronic sinusitis and gastroenteritis. The patient was infected with COVID-19, dengue (twice) and influenza and was hospitalized three times for intravenous antibiotic therapy. Ustekinumab did not influence the susceptibility of the patient with LOCID to severe infections and significantly improved psoriasis, psoriatic arthritis, and Crohn’s disease. |
| first_indexed | 2024-03-10T22:18:15Z |
| format | Article |
| id | doaj.art-49883ce6764d4bfdbf47c29ee8d2dff8 |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-03-10T22:18:15Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pathogens |
| spelling | doaj.art-49883ce6764d4bfdbf47c29ee8d2dff82023-11-19T12:22:51ZengMDPI AGPathogens2076-08172023-09-01129115610.3390/pathogens12091156Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case ReportLuiz Euribel Prestes-Carneiro0Marilda Aparecida Milanez Morgado de Abreu1Eduardo Vinicius Mendes Roncada2Diego Garcia Muchon3Fernanda Miranda Caliani4Dewton Moraes Vasconcelos5Immunodeficiencies and Infectious Diseases Outpatient Clinic, Faculty of Medicine, Oeste Paulista University, Presidente Prudente 19.050-920, BrazilDepartment of Dermatology, Faculty of Medicine, Oeste Paulista University, Presidente Prudente 19.050-920, BrazilDepartment of Dermatology, Faculty of Medicine, Oeste Paulista University, Presidente Prudente 19.050-920, BrazilImmunodeficiencies and Infectious Diseases Outpatient Clinic, Faculty of Medicine, Oeste Paulista University, Presidente Prudente 19.050-920, BrazilImmunodeficiencies and Infectious Diseases Outpatient Clinic, Faculty of Medicine, Oeste Paulista University, Presidente Prudente 19.050-920, BrazilLaboratory of Medical Investigation Unit 56, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo 05403 000, BrazilA 35-year-old man with a late-onset combined immunodeficiency (LOCID) variant of common variable immunodeficiency, severe plaque psoriasis, psoriatic arthritis, and Crohn’s disease was attended in the Regional Hospital of Presidente Prudente and HC-FMUSP, São Paulo, Brazil. Anti-IL-12/IL-23 (ustekinumab) monoclonal antibody was prescribed due to the failure of other treatments (phototherapy, oral acitretin) for psoriasis and a Psoriasis Area Severity Index >10. We evaluated the impact of treatment with ustekinumab on severe infectious diseases in a patient with uncontrolled psoriasis and LOCID followed for 8 years. Four quarterly doses of ustekinumab 90 mg and human immunoglobulin replacement (10,000 mg at 28-day intervals) were administered. Immunophenotyping, cultures of lymphocytes, genetic sequencing, and whole exome sequencing were performed to investigate the primary immunodeficiency. Normal lymphocyte proliferation; pathogenic variants in genetic sequencing, and clinically significant variants in the whole exome for primary immunodeficiencies were not detected. The main infections before and after treatment with ustekinumab were chronic sinusitis and gastroenteritis. The patient was infected with COVID-19, dengue (twice) and influenza and was hospitalized three times for intravenous antibiotic therapy. Ustekinumab did not influence the susceptibility of the patient with LOCID to severe infections and significantly improved psoriasis, psoriatic arthritis, and Crohn’s disease.https://www.mdpi.com/2076-0817/12/9/1156late-onset combined immunodeficiencypsoriasisustekinumabinfections |
| spellingShingle | Luiz Euribel Prestes-Carneiro Marilda Aparecida Milanez Morgado de Abreu Eduardo Vinicius Mendes Roncada Diego Garcia Muchon Fernanda Miranda Caliani Dewton Moraes Vasconcelos Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report Pathogens late-onset combined immunodeficiency psoriasis ustekinumab infections |
| title | Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report |
| title_full | Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report |
| title_fullStr | Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report |
| title_full_unstemmed | Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report |
| title_short | Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report |
| title_sort | impact of treatment with ustekinumab on severe infections in a patient with uncontrolled psoriasis and late onset combined primary immunodeficiency case report |
| topic | late-onset combined immunodeficiency psoriasis ustekinumab infections |
| url | https://www.mdpi.com/2076-0817/12/9/1156 |
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