Successful guselkumab treatment of a refractory psoriasis patient with Graves' disease: a case report

Abstract

Psoriasis is a chronic inflammatory skin disease. It is associated with many autoimmune diseases such as rheumatoid arthritis, Crohn's disease and thyroid diseases. Graves' disease (GD) is a common organ-specific autoimmune disease characterized by diffuse goitre and thyrotoxicosis. Management of psoriasis patients with GD is challenging. This current report presents the case of a 34-year-old female patient with refractory psoriasis with GD who was hospitalized for drug eruption and then experienced new-onset erythema and scaling following treatment with adalimumab and secukinumab. Despite the sequential move to phototherapy, tofacitinib and ustekinumab, the erythema and scaling continued unabated and exacerbated. Finally, switching to guselkumab resulted in the psoriasis lesions significantly improving. These findings suggest that guselkumab might be an effective treatment option for refractory psoriasis combined with GD.

Keywords: Graves’ disease; Guselkumab; biological agent; psoriasis; refractory.

Figure 1.

Clinical photographs of a 34-year-old female patient with Graves’ disease who presented with severe plaque psoriasis showing the response to treatment throughout the course of her treatment: (a) drug eruption lesions on the patient’s trunk when admitted; (b) the patient’s initial skin lesions receded after conventional therapies; (c) psoriatic lesions relapsed after treatment with adalimumab; (d) psoriatic lesions continued after treatment with secukinumab; (e) psoriatic lesions partly improved after phototherapy; psoriatic lesions resolved before (f) and after treatment with ustekinumab (g); (h) psoriatic lesions relapsed after treatment with ustekinumab for 1 year and (i) psoriatic lesions resolved after treatment with guselkumab for 3 months. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 2.

Changes in psoriatic lesions and medication regimen of a 34-year-old female patient with Graves’ disease who presented with severe plaque psoriasis. w, week; PASI, psoriasis area and severity index; SSPGA, SELENA SLEDAI Physician’s Global Assessment; TS, topical steroids. The colour version of this figure is available at: http://imr.sagepub.com.