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. 2018 Sep 20;2(4):370-377.
doi: 10.1016/j.mayocpiqo.2018.07.006. eCollection 2018 Dec.

Interstitial Pneumonia in Psoriasis

Hironori Kawamoto  1 , Hiromichi Hara  1 , Shunsuke Minagawa  1 , Takanori Numata  1 , Jun Araya  1 , Yumi Kaneko  1 , Yoshinori Umezawa  2 , Akihiko Asahina  2 , Hidemi Nakagawa  2 , Kazuyoshi Kuwano  1
Affiliations

Interstitial Pneumonia in Psoriasis

Hironori Kawamoto et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Objective: To investigate the relationship between psoriasis and interstitial pneumonia (IP).

Patients and methods: We analyzed the clinical data of patients with psoriasis treated with biologic agents from June 1, 2008, to June 30, 2017, retrospectively. Chest computed tomography was performed in 392 patients before treatment. The clinical characteristics and radiographic findings of these patients were evaluated.

Results: Of the 392 patients with psoriasis, IP was detected in 8 patients (2%). Bilateral ground-glass and/or irregular linear (reticular) opacity in the lower lung zone was the most common chest computed tomography finding. Five of the 8 patients with IP were treated with anti-interleukin (IL) 12/IL-23 or IL-17 antibodies, leading to decreased or stable IP activity.

Conclusion: Interstitial pneumonia was detected in 2% of patients with psoriasis who needed systemic treatments. Ground-glass and/or irregular linear (reticular) opacity in the bilateral lower lobes was characteristic of IP with psoriasis. The IL-23/IL-17 axis may play important roles in the pathogenesis of IP in psoriasis.

Keywords: CT, computed tomography; IL, interleukin; IP, interstitial pneumonia; KL-6, Krebs von den Lungen-6; PASI, psoriasis area severity index; SEC, secukinumab; UST, ustekinumab.

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Figures

Figure 1
Figure 1
A, Ground-glass and irregular linear (reticular) opacity was distributed along the bronchial vascular bundle in the lower lobes on chest computed tomography (CT) of case 1 (61-year-old man). Chest CT in case 2 (67-year-old man) (B) and case 5 (75-year-old man) (E) showed subpleural ground-glass and irregular linear (reticular) opacity distributed in the lower lobes. Subpleural linear opacity was shown on CT in case 3 (68-year-old man) (C) and case 4 (75-year-old man) (D).
Figure 2
Figure 2
The relationship between IP activity and psoriasis activity in case 6, a 72-year-old man. Interstitial pneumonia activity was evaluated by chest CT and serum KL-6, and psoriasis activity was assessed by PASI scores. Chest CT showed subpleural ground-glass and irregular linear (reticular) opacity distributed in the lower lobes. Interstitial pneumonia activities fluctuated in accordance with psoriasis activity. Used with permission of Eur J Dermatol. CT = computed tomography; IP = interstitial pneumonia; KL-6 = Krebs von den Lungen-6; PASI = psoriasis area severity index; UST = ustekinumab.
Figure 3
Figure 3
The chest CT, KL-6 levels, and PASI score of case 7 (77-year-old man) are shown. Ground-glass opacities along the bronchial vascular bundle were ameliorated by treatment with UST with decreased KL-6 levels and PASI scores. CT = computed tomography; KL-6 = Krebs von den Lungen-6; PASI = psoriasis area severity index; UST = ustekinumab.
Figure 4
Figure 4
The chest CT, KL-6 levels, and PASI score of case 8 (81-year-old man) are shown. Subpleural ground-glass and irregular linear (reticular) opacity distributed in the lower lobes improved with UST treatment temporarily. Discontinuation of the treatment worsened both IP and psoriasis. CT = computed tomography; IP = interstitial pneumonia; KL-6 = Krebs von den Lungen-6; PASI = psoriasis area severity index; UST = ustekinumab.
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