Ixekizumab

Abstract

S Ixekizumab Lymphocytic sialadenitis, erythema nodosum and elevation of liver transaminase levels: case reportA 25-year-old man developed lymphocytic sialadenitis, erythema nodosum and elevation of liver transaminase levels during treatment with ixekizumab [dosage and route not stated].The man, with a 8 year history of chronic plaque psoriasis, had been receiving ixekizumab in a clinical trial with significant but incomplete improvement. He presented to the hospital with complaints of severe pain associated with 1 week old oral ulcers and difficulty in swallowing. On examination, the oral mucosa showed multiple erosions and vesicles with underlying background erythema, involving the hard and soft palate, gingiva, and lips. Over the next 24 hours, he became febrile and erythematous tender nodules developed on the extensor surfaces of his legs and distal upper extremities. These findings were consistent with erythema nodosum. A biopsy of the mucosal upper lip revealed dense lymphoplasmacytic infiltrate surrounding the minor salivary glands and the salivary duct with mucositis and surface ulceration, suggestive of lymphocytic sialadenitis. A biopsy of the lower extremity revealed an early septal panniculitis, corroborated the previous finding of erythema nodosum. In addition, his laboratory investigations revealed a mild elevation of AST, ALT, ESR and CRP.The man was initially prescribed valaciclovir [valacyclovir], prednisone, and viscous lidocaine without improvement. and then treated with methylprednisolone, which showed remarkable improvement. He was discharged after 3 days of hospitalisation.Author comment: "We report a case of lymphocytic sialadenitis in the setting of ixekizumab treatment for psoriasis" " [O]ther adverse reactions can include neutropenia, elevation of liver transaminase levels, sialadenitis, and erythema nodosum". Purnell JC, et al. Mucocutaneous findings associated with interleukin (IL)-17 inhibition. JAAD Case Reports 2: 92-94, No. 1, Jan 2016. Available from: URL: http://doi.