engleski

Severe Gram-negative Sepsis During Guselkumab Treatment for Psoriasis – A Case Report

Introduction: A newer therapeutic option for psoriasis is guselkumab, a high-affinity inhibitor of the p19 subunit of IL-23. Here we report a case of severe, gram negative infection associated with guselkumab. Case: A 42- year old female with a history of generalised pustular psoriasis was admitted in ICU in severe condition during treatment with guselkumab. Treatment with guselkumab was started 3 months before this admission and was administered according to label (100 mg at weeks 0 and 4 and every 8 weeks thereafter). On admission, the patient was hemodynamic unstable (arterial blood pressure 60/40 mmHg). Norepinephrine, vasopressin, and hydrocortisone was introduced. Second day of hospitalisation in ICU urine and blood cultures revealed Gram- negative organism Proteus mirabilis. Empiric antibiotic therapy started with intravenous meropenem and vancomicin, later intravenous fosfomycin was added. She was submitted to continuous renal replacement therapy with the hemoadsortion. In next days patient become hemodynamic stable and gradually was weaned from intensive therapy. Conclusion: According to VOYAGE 2 trial, three serious infections were observed in the active treatment group (bronchitis, erysipelas, and soft tissue infection) ; and one serious infection was noticed in the maintenance group (appendicitis). In the ECLIPSE trial, investigators reported six serious infections in guselkumab-treated patients. This is the first report of a severe Proteus mirabilis infection in a patient receiving guselkumab.

sepsic shock, psoriasis, immunotherapy

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