生物学的製剤による治療中に水疱性類天疱瘡を続発した膿疱性乾癬

・抗TNF-α抗体製剤による治療中に水疱性類天疱瘡を発症した膿疱性乾癬を経験した．

・抗TNF-α抗体製剤中止のうえ，プレドニゾロン（PSL）全身投与で類天疱瘡の病変の改善を認めたが，PSL漸減中に膿疱性乾癬の再燃を認めた．

・免疫グロブリン大量静注療法に加え，セクキヌマブを併用した結果，膿疱性乾癬と類天疱瘡のどちらに対しても良好な治療経過を得ることができた．

（「症例のポイント」より）

　

A case of pustular psoriasis treatment with biologics associated with bullous pemphigoid of subsequent development

　

Kaneko, Yuki1）Hayashi, Shujiro1）Otani, Yokurei1）Hamasaki, Yoichiro1）Igawa, Ken1） 1）Department of Dermatology, Dokkyo Medical University School of medicine

　

A 41-year-old man with a 31-year history of pustular psoriasis, had been treated with prednisolone, etretinate and cyclosporine. He had started treatment with infliximab since 2010 to 2013, then switched the therapy with other biological drug to adalimumab, due to developing recurrence of skin pustules, fever and headache. It was considered the infusion reaction by infliximab. In 2014, tense bullae appeared on his trunk and limbs. Histopathological findings of skin lesions on the skin blister were consistent with bullous pemphigoid, a subepidermal blister with inflammatory infiltrate composed of lymphocytes and eosinophils within the blister and in the superficial dermis. Positive results were found for anti BP180NC16a antibody (226 U/ml； normal ＜9.0 U/ml). Skin lesions improved on administering a combination therapy of oral prednisolone, high-dose　intravenous immunoglobulin and secukinumab.