Adalimumab induced exacerbation of psoriasis in patients with combined pemphigus: A case report

Abstract

Rationale: Psoriasis is an immune-related disease caused by genetic factors, abnormalities in the immune system and environmental factors, while pemphigus is an autoimmune disease caused by the autoimmune system attacking the skin and mucosal tissues. Herein, we aimed to report a rare case of adalimumab induced exacerbation of psoriasis patients with pemphigus. The rare disease causes considerable challenges for clinical diagnosis and treatment. Patient concerns: The patient was a 43-year-old man with intermittent erythema and scaling all over the body for more than 20 years, and blisters and vesicles on the trunk and limbs for 1 month. Half a year ago, the patient had blisters on the limbs, and was diagnosed with deciduous pemphigus in a hospital, and the blisters subsided after being given traditional Chinese medicine orally. Half a month ago, the erythema area was enlarged, and adalimumab 80 mg intramuscular injection was given for 1 time after consultation in the hospital. On the following day, the area of erythema and scales was suddenly enlarged obviously compared with the previous 1, and obvious blisters and vesicles appeared on the limbs, neck, and trunk, which were aggravated progressively and accompanied by obvious itching and pain. Diagnoses: The patient was diagnosed with psoriasis in patients with combined pemphigus. Intervention: After combined treatment with methylprednisolone and cyclosporine, the skin lesions have basically recovered. Outcomes: The skin lesions have basically healed. Follow up for 6 months without recurrence. Lessons: Methylprednisolone combined with cyclosporine may be an option in treating patients with psoriasis patients with pemphigus.