インフリキシマブからウステキヌマブ変更後にも逆説的副反応として出現した膿疱性乾癬

・Crohn病に対してインフリキシマブを投与したところ，逆説的副反応（paradoxical reaction）として膿疱性乾癬が発症した．シクロスポリン投与により症状は軽快したが，ウステキヌマブを導入したところ，11カ月後に膿疱性乾癬が再燃した．生物学的製剤による加療中に膿疱性乾癬などの逆説的副反応の出現を認めた場合，生物学的製剤の中止とともに，他の生物学的製剤への変更を考慮するのが通常である．他の生物学的製剤への変更を行っても，逆説的副反応がおこりうる可能性があることも念頭に置いておく必要がある．

（「症例のポイント」より）

　

A case of pustular psoriasis as a paradoxical reaction even after changing the treatment from infliximab to ustekinumab

　

Takeuchi, Chihiro1）Harada, Tomoka1）Kitani, Mikono1）Takeuchi, Seiji1）Shimizu, Hideki1）Adachi, Atsuko2） 1）Department of Dermatology, Sanda City Hospital 2）Department of Dermatology, Hyogo Prefectural Kakogawa Medical Center

　

A 37-year-old man with Crohn’s disease was treated with infliximab；however, he became febrile and developed systemic exanthema after 1 year. He was diagnosed with pustular psoriasis occurring as a paradoxical reaction to infliximab. Therefore, infliximab was replaced with ustekinumab；however, the same symptoms recurred after approximately 11 months. Currently, administration of biological preparations has been discontinued, and the patient’s progress is being monitored, without symptom recurrence with cyclosporine treatment for both pustular psoriasis and Crohn’s disease. This suggests the possibility of a paradoxical reaction occurring even after changing the biological preparation to one with a different mechanism of action.