Secukinumab-induced systemic lupus erythematosus in psoriatic arthritis
Authors
Pedro Ávila-Ribeiro; Ana Rita Lopes; Joana Martins-Martinho; Estela Nogueira; Joana Antunes; José Carlos Romeu; Ana Rita Cruz-Machado; Elsa Vieira-Sousa;
Keywords
Case report: A 68-year-old male treated with secukinumab for psoriatic arthritis suspended treatment for three months due to COVID pandemic. Upon secukinumab reintroduction, anorexia and weight loss ensued and four months later he had an abrupt onset of low-grade fever, fatigue, flu-like symptoms, dyspnoea and widespread inflammatory arthralgias. Laboratory investigations showed de novo anaemia, leukopenia, lymphopenia, cytocholestasis, elevated acute phase reactants, C3 complement consumption, proteinuria (1630mg/24h), active urine sediment, positive antinuclear (1:1280) and anti-double-stranded DNA (212.3 IU/mL) antibodies. Chest imaging showed peripheral pulmonary embolism, lobar pneumonia, and a small bilateral pleural effusion. Drug-induced lupus erythematosus (DILE) was suspected, and the patient was hospitalised. Secukinumab was discontinued and treatment with enoxaparin, antibiotics, enalapril, hydroxychloroquine and prednisolone 0.5mg/kg qd was started. Clinical and laboratorial remission ensued after one month except for proteinuria (decreased to 653mg/24h). Proliferative lupus nephritis was assumed and mycophenolate mofetil was introduced, with sustained complete remission over a 33-month follow-up.
Discussion: This is the second reported case of systemic secukinumab-associated DILE, and the first with renal involvement. Clinical and laboratory features of DILE are reviewed and compared with previously described cases.
Pedro Ávila-Ribeiro
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Ana Rita Lopes
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Joana Martins-Martinho
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Estela Nogueira
Serviço de Nefrologia e Transplantação Renal, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
Joana Antunes
Serviço de Dermatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
José Carlos Romeu
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Ana Rita Cruz-Machado
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Elsa Vieira-Sousa
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Ana Rita Lopes
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Joana Martins-Martinho
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Estela Nogueira
Serviço de Nefrologia e Transplantação Renal, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
Joana Antunes
Serviço de Dermatologia, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML)
José Carlos Romeu
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Ana Rita Cruz-Machado
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
Elsa Vieira-Sousa
Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network
