Department of Immunology, Zurich University Hospital, Zurich, Switzerland.
Department of Dermatology, Zurich University Hospital, Zurich, Switzerland.
Br J Dermatol. 2018 Feb;178(2):551-555. doi: 10.1111/bjd.15631. Epub 2017 Nov 28.
Here we report the case of a patient with psoriasis who developed ulcerative colitis most likely caused by adalimumab. After cessation of adalimumab, colitis improved significantly. However, as psoriasis worsened, the patient was switched to ustekinumab, which resulted in complete cessation of colitis. During the 2-year follow-up under ustekinumab therapy, no further gastrointestinal complaints occurred. Paradoxical psoriasis manifestations in inflammatory bowel disease (IBD) under tumour necrosis factor (TNF)-inhibitor therapy have been reported and paradoxical IBD occurred rarely (mostly Crohn disease) in patients with rheumatological conditions treated with infliximab or etanercept. Due to the highly probable association of adalimumab with the onset of colitis in this case, we would like to suggest the term 'paradoxical ulcerative colitis' (PUC) for this as yet extremely rarely reported phenomenon. To the best of our knowledge this is the first description of PUC in a patient with psoriasis and in adalimumab treatment. Our observation suggests that ustekinumab is an effective treatment option in patients with paradoxical anti-TNF-driven inflammatory reactions like psoriasis or IBD.
在这里，我们报告了一例银屑病患者发生溃疡性结肠炎的病例，该患者可能是由阿达木单抗引起的。停用阿达木单抗后，结肠炎明显改善。然而，随着银屑病的恶化，患者转为乌司奴单抗治疗，这导致结肠炎完全停止。在乌司奴单抗治疗的 2 年随访期间，患者未再出现胃肠道不适。在肿瘤坏死因子（TNF）抑制剂治疗下，炎症性肠病（IBD）中出现矛盾性银屑病表现已有报道，而在接受英夫利昔单抗或依那西普治疗的风湿性疾病患者中，罕见发生矛盾性 IBD（主要为克罗恩病）。由于在本例中阿达木单抗极有可能与结肠炎的发生有关，我们建议将这种现象称为“矛盾性溃疡性结肠炎”（PUC）。据我们所知，这是首例在银屑病患者和阿达木单抗治疗中发生 PUC 的描述。我们的观察表明，乌司奴单抗是治疗银屑病或 IBD 等 TNF 驱动的炎症反应矛盾性疾病的有效治疗选择。
