Delayed drug hypersensitivity reaction to secukinumab in a patient with hidradenitis suppurativa

Abstract

A woman in her 30s presented to the dermatology clinic with widespread, pruritic, red papules and plaques involving the ears, trunk and extremities. The rash developed a few days after receiving her second injection of secukinumab, which was initiated for recalcitrant Hurley stage III hidradenitis suppurativa. Investigations revealed a psoriasiform drug hypersensitivity reaction secondary to secukinumab. In this report, we describe the clinical course, histopathological correlation and treatment of this rarely documented reaction.

Keywords: Dermatology; Hidradenitis suppurativa; Skin; Unwanted effects / adverse reactions.

Figure 1

Visual timeline representing chronology of hypersensitivity reaction and prior medication use.

Figure 2

Clinical images of cutaneous delayed-type hypersensitivity (type IV) reaction to secukinumab. (A, B) Indurated, erythematous, scaly, crusted plaques with associated maceration on the bilateral axillary folds, as well as scattered erythematous papules and papulonodules on the abdomen and bilateral inframammary folds; taken 4 months after surgical excision of axillary hidradenitis suppurativa lesions and 6 weeks after initial onset of the eruption. (C, D) Resolution of the cutaneous hypersensitivity reaction 6 weeks after discontinuation of secukinumab and initiation of a prolonged prednisone taper.

Figure 3

Histological images of cutaneous delayed-type hypersensitivity (type IV) reaction to secukinumab. Low-power (A) and high-power views (B) showing regular epidermal hyperplasia with spongiosis and serous crusting with ample neutrophils in the stratum corneum, as well as a superficial perivascular and interstitial infiltrate of lymphocytes and numerous eosinophils. Periodic acid-Schiff stain was negative for fungal elements (not shown).