Sun Frances Sze Kei, Chiu Nicole Sau Yan, Chung Ho Yin
Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong, China.
Division of Rheumatology, Chiron Medical Group, 26/F, 9 Queen's Road, Central, Hong Kong, China.
BMC Rheumatol. 2023 Aug 8;7(1):25. doi: 10.1186/s41927-023-00344-9.
Behcet's disease (BD) is a systemic disease characterized by recurrent oral and genital ulcers. The underlying disease pathway likely involves interleukin (IL)-17 A, a proinflammatory cytokine that is implicated in Behcet's uveitis. Secukinumab is an anti-IL-17 A drug that may have an emerging role in the treatment of refractory BD. This is the first known case report of gastrointestinal BD flare up after anti-IL-17 A therapy.
We presented a case of BD with cutaneous and articular features being treated with secukinumab. After the third dose of loading secukinumab, the patient developed acute lower abdominal pain required hospital admission. Urgent computer tomography (CT) abdomen showed fatty stranding of caecum. Colonoscopy with caecal showed increased number of inflammatory cells in lamina propria. Secukinumab was stopped and patient was started on medium dose steroid. His abdominal symptoms resolved after treatment.
This case report illustrates a case of gastrointestinal (GI) BD presenting as acute inflammatory colitis after the use of secukinumab. Therefore, anti-IL-17 A agents should be used cautiously in patients with GI BD, and preferably guided by a phenotype-tailored approach.
白塞病（BD）是一种以复发性口腔和生殖器溃疡为特征的全身性疾病。潜在的疾病途径可能涉及白细胞介素（IL）-17A，一种与白塞病葡萄膜炎有关的促炎细胞因子。司库奇尤单抗是一种抗IL-17A药物，可能在难治性BD的治疗中发挥新作用。这是已知的第一例抗IL-17A治疗后胃肠道BD发作的病例报告。
我们报告了一例患有皮肤和关节症状的BD患者接受司库奇尤单抗治疗的病例。在第三次负荷剂量的司库奇尤单抗治疗后，患者出现急性下腹痛，需要住院治疗。腹部紧急计算机断层扫描（CT）显示盲肠脂肪浸润。结肠镜检查显示盲肠固有层炎症细胞数量增加。停用司库奇尤单抗，患者开始接受中等剂量的类固醇治疗。治疗后其腹部症状缓解。
本病例报告说明了一例使用司库奇尤单抗后出现急性炎症性结肠炎的胃肠道（GI）BD病例。因此，对于GI BD患者，应谨慎使用抗IL-17A药物，最好采用根据表型定制的方法进行指导。
