No abstract

Psoriasis is relatively common in clinical practice, whereas niacin deficiency is relatively rare. We describe the clinical case of a patient with plaque psoriasis for over 20 years who also had a concomitant latent tuberculosis infection. After secukinumab and anti-tuberculosis treatment for 1 year, the psoriatic rash mostly resolved, but atypical symptoms of niacin deficiency suddenly appeared. The patient’s symptoms rapidly subsided after experimental treatment with niacin. After 2 weeks, the patient suddenly developed an erythroderma-like rash, manifesting as large areas of erythema and plaque psoriasis throughout the body. The patient was admitted to the hospital and treated with an anti-inflammatory, biologic adalimumab, tripterygium glycoside, and sodium thiosulfate. The patient was discharged after a week. This case suggests the need for caution and to look out for the emergence of new symptoms when treating patients with moderate-to-severe plaque psoriasis, especially with biologics.

Sintilimab is a recombinant fully human anti-programmed cell death protein 1 (PD-1) monoclonal antibody that blocks the interaction of PD-1 with its ligand. It was approved to use in patients with gastric malignancy. Toxic epidermal necrolysis (TEN) is a rare, life-threatening cutaneous drug reaction. Here, we report a 70-year-old female patient with gastric malignancy who developed severe TEN 10 days after initiation of sintilimab. The patient did not respond to the systemic corticosteroids and intravenous immunoglobulin therapies but improved after the subcutaneous injection of adalimumab (40 mg) that is a monoclonal antibody directed against antitumor necrosis factor-α. Her rashes rapidly resolved within 24 hr. By the seventh day, the bullae had scabbed and most skin lesions had subsided. The patient showed no sign of organ dysfunction. This is the first reported case of immune checkpoint inhibitor-induced TEN successfully treated with adalimumab.