Behcet’s-like disease induced by secukinumab in a patient with psoriasis: a case report and literature review

Figures & data

Figure 1. Clinical findings of the patient. (A) Psoriasis plaques involving her lower leg before secukinumab therapy; (B) Multiple eruptive papulopustules on the face; (C) Several oral ulcers involving her palate and tongue (as arrows); (D) Scattered subcutaneous nodules on her legs (as arrows).

Figure 2. Histological findings of the patient. (A) A pattern of inflammatory cell infiltration in both the superficial and deep dermal layers, accompanied by mixed lobular and septal panniculitis; (B) A predominance of lymphocytes, neutrophils, and eosinophils within the inflammatory infiltrate. Hematoxylin and eosin, original magnification: (a) ×20; (b) ×100.

Table 1. Reported patients’ characteristics of IL-17 inhibitor associated behcet’s-like disease.

Patient	References	Age (years)	Sex	Previous history	Biologics	Interval time (weeks)	Symptoms	Pathergy test	HLA-B51	Parodoxical reaction	Clinical outcome
1	H. Shiga et al.	56	Male	Psoriasis	Secukinumab	8	High fever, abdomnal pain, refractory oral ulcerations, and genital folliculitis	NA	Negative	Behcet’s disease-like Lesions, Crohn’s Disease	Regressed with secukinumab withdrawal and oral prednisolone
2	E. Dincses et al.	34	Male	Ankylosing spondylitis	Secukinumab	4	Multiple oral and genital ulcers, arthritis of the knee with fever (38°C)	NA	Positive	Behcet’s syndrome	Regressed with secukinumab withdrawal, prednisolone, certolizumab
3	E. Dincses et al.	29	Male	Ankylosing spondylitis	Secukinumab	3	Fever (38–39°C), multiple oral and genital ulcers, bilateral lower extremity superficial thrombophlebitis and bilateral panuveitis	NA	Negative	Behcet’s syndrome	Regressed with methylprednisolone, infliximab, and secukinumab withdrawal
4	N. Barrado-Solis et al.	46	Female	Psoriasis	Secukinumab	2	High fever, oral and genital ulcers, nodular erythematous painful lesions on the lower limbs	Positive	Positive	Behcet’s disease	Improved with oral corticosteroid therapy and discontinuing suspected drug
5	N. Barrado-Solis et al.	48	Male	Psoriasis	Secukinumab	24	Uveitis, multiple oral and perianal ulcers, painful subcutaneous nodular and papulopustules lesions on the limbs and back	Negative	Negative	Behcet’s disease	Improved with oral corticosteroid therapy and discontinuing suspected drug
6	A. Calleja Algarra et al.	45	Female	Psoriasis	Secukinumab	40	Diffuse papulopustular eruptions on the trunk and extremities, painful oral and genital ulcers	NA	Positive	Behcet’s-like disease	Regressed with oral corticosteroids, apremilast, and discontinuing suspected drug
7	D. Chen et al.	46	Female	Psoriasis	Ixekizumab	12	Painful oral and vulvar ulcerations	NA	NA, but HLA-B13/B50 positive	Behcet’s-like disease	Healed with topical glucocorticoids and discontinuing suspected drug
8	C. Avci et al.	43	Male	Hidradenitis suppurativa	Secukinumab	10	Hyperemia and edema evolving to painful ulcerations on the axillary folds; Pustules and papules on the sternum, back, legs, and buttocks; A single genital ulcer and two oral ulcer	Negative	Positive	Behcet’s-like disease, pyoderma gangrenosum	Improved with secukinumab withdrawal, intravenous piperacillin- tazobactam, colchicine, topical corticosteroid, and good ulcer care
9	M. Ogasawara et al.	53	Female	Ankylosing spondylitis	Secukinumab	NA	Extensive aphthous ulcer lesions in the oral, pharyngolaryngeal, esophageal, gastric, and duodenal mucosae; Ulcerative lesions were present on the vulva.	NA	NA	Behcet’s-like disease	Complete resolution with prednisolone and discontinuing secukinumab

NA: Not available.