Clayton Helena, Flatz Lukas, Vollenweider-Roten Sonia, Schoepfer Alain, Gilliet Michel, Conrad Curdin
Department of Dermatology, University Hospital CHUV, Lausanne, Switzerland.
Dermatology. 2013;227(3):193-6. doi: 10.1159/000351714. Epub 2013 Oct 31.
Psoriasis is accepted as a multisystemic disease with several important systemic manifestations. Thus, underlying comorbidities have to be taken into account in the choice of treatment.
To explore the role of anti-TNF therapy in the treatment of psoriasis in a patient with acute-on-chronic pancreatitis.
Here, we present the case of a 75-year-old patient with severe psoriasis also suffering from chronic alcohol-induced pancreatitis with recurrent acute flares. A recent life-threatening episode of acute pancreatitis and ischemic liver precluded the reintroduction of methotrexate. Cyclosporine was also excluded as it has been reported to induce acute pancreatitis. Thus, an anti-TNF treatment was initiated in close collaboration with a gastroenterologist.
A year after starting anti-TNF therapy the patient continues to show complete clinical remission of his psoriasis. No side effects, particularly no bacterial infections, were reported. No relapses of the patient's underlying chronic pancreatitis were observed throughout the entire treatment with regular clinical and laboratory monitoring, suggesting that chronic pancreatitis is not per se a contraindication for anti-TNF therapy.
This case study opens the way for further questioning on the role of TNF in the pathogenesis of chronic and acute pancreatitis and the use of anti-TNF therapy in its treatment.
银屑病被认为是一种具有多种重要全身表现的多系统疾病。因此，在选择治疗方法时必须考虑潜在的合并症。
探讨抗TNF治疗在一名慢性胰腺炎急性发作患者的银屑病治疗中的作用。
在此，我们报告一例75岁的严重银屑病患者，该患者还患有慢性酒精性胰腺炎且反复发作急性发作。最近一次危及生命的急性胰腺炎和缺血性肝病发作使甲氨蝶呤无法重新使用。环孢素也被排除，因为据报道它会诱发急性胰腺炎。因此，与胃肠病学家密切合作启动了抗TNF治疗。
开始抗TNF治疗一年后，患者的银屑病仍处于完全临床缓解状态。未报告任何副作用，尤其是未发生细菌感染。在整个治疗过程中，通过定期的临床和实验室监测，未观察到患者潜在的慢性胰腺炎复发，这表明慢性胰腺炎本身并非抗TNF治疗的禁忌证。
本病例研究为进一步探讨TNF在慢性和急性胰腺炎发病机制中的作用以及抗TNF治疗在其治疗中的应用开辟了道路。
