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Impact of Treatment with Ustekinumab in Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report
Prestes-Carneiro, L.E.; Morgado de Abreu, M.A.M.; Roncada, E.V.M.; Muchon, D.G.; Caliani, F.M.; Vasconcelos, D.M. Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report. Pathogens2023, 12, 1156.
Prestes-Carneiro, L.E.; Morgado de Abreu, M.A.M.; Roncada, E.V.M.; Muchon, D.G.; Caliani, F.M.; Vasconcelos, D.M. Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report. Pathogens 2023, 12, 1156.
Prestes-Carneiro, L.E.; Morgado de Abreu, M.A.M.; Roncada, E.V.M.; Muchon, D.G.; Caliani, F.M.; Vasconcelos, D.M. Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report. Pathogens2023, 12, 1156.
Prestes-Carneiro, L.E.; Morgado de Abreu, M.A.M.; Roncada, E.V.M.; Muchon, D.G.; Caliani, F.M.; Vasconcelos, D.M. Impact of Treatment with Ustekinumab on Severe Infections in a Patient with Uncontrolled Psoriasis and Late-Onset Combined Primary Immunodeficiency: Case Report. Pathogens 2023, 12, 1156.
Abstract
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 attended Regional Hospital of Presidente Prudente and HC-FMUSP, São Paulo, Brazil. Anti-IL-12/IL-23 (ustekinumab) monoclonal antibody was prescribed due to failure of other treatments (phototherapy, oral acitretin) for psoriasis and Psoriasis Area Severity Index <10. We evaluated the impact of ustekinumab, a potent immunosuppressor, on the risk of infectious diseases in this patient 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, culture of lymphocytes, genetic sequencing, and whole exome sequencing were performed to investigate the primary immunodeficiency. Normal lymphocyte proliferation, absence of pathogenic variants in the genes analyzed and no clinically significant variants were detected in the whole exome. The main infections included chronic sinusitis, tonsillitis, fungal and bacterial otitis, gastroenteritis, and community-acquired pneumonia. The patient was infected with COVID-19, dengue (twice), and influenza and was hospitalized three times for intravenous antibiotic therapy. Ustekinumab did not influence susceptibility to severe infections and significantly improved psoriasis, psoriatic arthritis, and Crohn's disease in a patient with LOCID.
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