Skip to main content Skip to main navigation menu Skip to site footer

Psoriasis vulgaris dengan anti-HCV reaktif yang diterapi injeksi secukinumab



Abstract

Background: Psoriasis vulgaris is an inflammatory skin disease characterized by epidermal hyperplasia, and Hepatitis C Virus (HCV) is reported to be one of the infections that can trigger psoriasis. Treatment safety is a particular concern, especially in patients with comorbidities. This case report describes an asymptomatic hepatitis C condition that can trigger psoriasis and is an important concern in administering biological agent therapy, especially secukinumab.

Case: A 42-year-old man, with the main complaint of reddish spots accompanied by scales on the body, arms and legs that have been worsening since 1 month ago. The patient was diagnosed with psoriasis vulgaris 6 years ago from history and physical examination with methotrexate treatment for 3 years. During therapy, the patient complained of yellowing of the body and tired easily found an increase in liver function 3 times the normal value during monitoring and found reactive anti-HCV and an increase in HCV RNA titer (diagnosed with chronic hepatitis C infection). The therapy was given as direct-acting antiviral (DAA) for 3 months and only topical steroids for skin lesions. After DAA therapy, the patient started subcutaneous injections of secukinumab 150 mg for 6 cycles when the PASI score was 11 and found clinical improvement and markers of hepatitis C infection.

Conclusion: There are not much data regarding the efficacy of using secukinumab in psoriasis with reactive anti-HCV, which hepatitis C is suspected as the trigger of psoriasis. Evaluation after DAA therapy and injection of 6 cycles of secukinumab found improvement of the lesion and undetectable HCV RNA titers.

 

Latar belakang: Psoriasis vulgaris adalah penyakit inflamasi kulit yang ditandai dengan hiperplasia epidermal dan hepatitis C virus (HCV) dilaporkan menjadi salah satu infeksi yang dapat mencetuskan psoriasis. Keamanan terapi menjadi perhatian khusus terutama pada kondisi pasien dengan komorbiditas. Laporan kasus ini menjelaskan kondisi hepatitis C asimptomatis dapat mencetuskan psoriasis dan menjadi perhatian penting pada pemberian terapi agen biologis, khususnya secukinumab.

Kasus: Seorang laki-laki berumur 42 tahun, dengan keluhan utama berupa bercak kemerahan disertai sisik di badan, lengan dan tungkai yang memberat sejak 1 bulan yang lalu. Pasien didiagnosa psoriasis vulgaris sejak 6 tahun lalu dari anamnesis dan pemeriksaan fisik dengan pengobatan metotrexat selama 3 tahun. Selama terapi pasien mengeluhkan tubuh menguning dan mudah lelah serta ditemukan peningkatan fungsi hati 3 kali nilai normal saat monitoring dan ditemukan anti-HCV reaktif, serta peningkatan titer RNA HCV (didiagnosis dengan infeksi hepatitis c kronis). Terapi yang diberikan berupa direct acting antiviral (DAA) selama 3 bulan dan hanya topikal steroid untuk lesi kulit. Pasca terapi DAA pasien memulai injeksi secukinumab 150 mg subkutan sebanyak 6 siklus saat skor PASI 11 dan ditemukan perbaikan klinis serta marker infeksi hepatitis C.

Simpulan: Belum terdapat banyak data mengenai efikasi penggunaan secukinumab pada psoriasis dengan anti-HCV reaktif, dengan adanya kecurigaan hepatitis C sebagai pencetus psoriasis. Evaluasi pasca terapi DAA dan injeksi 6 siklus secukinumab ditemukan perbaikan lesi dan titer HCV RNA tidak terdeteksi.

Keywords: psoriasis vulgaris anti-HCV reaktif injeksi secukinumab

References

  1. Gudjonsson JE, Elder JT. Psoriasis. In: Kang S, Amagi M, Bruckner AL, Enk AH, Margolis D, McMichael A, et al., editors. Fitzpatrick’s Dermatology 9th Edition. New York: Mc Graw Hill Education; 2019. p. 457–97.
  2. Wardhana M, Adiguna MS, Nareswari PAD. Positive correlation of psoriasis vulgaris severity and HOMA-IR. Bali Dermatology Venereol J. 2019;2(1):17–20.
  3. Anonim. Buku Register Kunjungan Poliklinik Kulit Dan Kelamin Rumah Sakit Umum Pusat RSUP Prof. dr. I G. N. G. Ngoerah, Denpasar. Rumah Sakit Umum Pus RSUP Prof dr I G N G Ngoerah. 2021;
  4. Farag A, Elshayb E. Role of HCV Infection in Psoriasis: A Clinical and Immunohistochemical Study. J Clin Diagnostic Res. 2019;13(5):1–6.
  5. Liu Y, Cui SN, Duan MY, Dou ZL, Li YZ, Liu YX, et al. Is there a relationship between psoriasis and hepatitis C? A meta-analysis and bioinformatics investigation. Virol J. 2021;18(1):1–10.
  6. Barrea L, Nappi F, Di Somma C, Savanelli MC, Falco A, Balato A, et al. Environmental risk factors in psoriasis: The point of view of the nutritionist. Int J Environ Res Public Health. 2016;13(7):1–12.
  7. WHO. Hepatitis C: fact sheet. 2021 (disitasi pada: September 2022). Dapat diakses pada: https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
  8. Webster DP, Klenerman P, Collier J, Jeffery KJ. Development of novel treatments for hepatitis C. Lancet Infect Dis. 2009;9(2):108–17.
  9. Sansone S, Guarino M, Castiglione F, Rispo A, Auriemma F, Loperto I, et al. Hepatitis B and C virus reactivation in immunosuppressed patients with inflammatory bowel disease. World J Gastroenterol. 2014;20(13):3516–24.
  10. Mahale P, Kontoyiannis DP, Chemaly RF, Jiang Y, Hwang JP, Davila M, et al. Acute exacerbation and reactivation of chronic hepatitis C virus infection in cancer patients. J Hepatol. 2012;57(6):1177–85.
  11. European Association for the Study of the Liver. EASL Recommendations on Treatment of Hepatitis C 2018. J Hepatol. 2018;69(2):461–511.
  12. Soliman A, El hawari S, Refaey M, Ahmed N, Emara M. Extrahepatic manifestations of Hepatitis C virus: an extending list. Afro-Egypt J Infect Endem Dis. 2012;2(1):36–53.
  13. Chun K, Afshar M, Audish D, Kabigting F, Paik A, Gallo R, et al. Hepatitis C may enhance key amplifiers of psoriasis. J Eur Acad Dermatology Venereol. 2017;31(4):672–8.
  14. Maybury CM, Jabbar-Lopez ZK, Wong T, Dhillon AP, Barker JN, Smith CH. Methotrexate and liver fibrosis in people with psoriasis: A systematic review of observational studies. Br J Dermatol. 2014;171(1):17–29.
  15. Cetinkaya A, Bulbuloglu E, Kurutas E, Kantarceken B. N-acetylcysteine ameliorates methotrexate induced oxidative liver damage in rats. Med Sci. 2006;12:274–8.
  16. Ozogula B, Kisaoglua A, Turanb M, Altunerc S. The effect of mirtazapine on methotrexate-induced toxicity in rat liver. ScienceAsia. 2013;93:356–62.
  17. Wu JJ, Merola JF, Feldman SR, Menter A, Lebwohl M. Treatment of Psoriasis with Secukinumab in Challenging Patient Scenarios: A Review of the Available Evidence. Dermatol Ther (Heidelb). 2020;10(3):351–64.
  18. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: Case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137–74.
  19. Huang Z, van Velkinburgh J, Ni B, Wu Y. Pivotal roles of the interleukin-23/T helper 17 cell axis in hepatitis B. Liver Int. 20121;32:894–901.
  20. Lande R, Gregorio J, Facchinetti V, Chatterjee B, Wang YH, Homey B, et al. Plasmacytoid dendritic cells sense self-DNA coupled with antimicrobial peptide. Nature. 2007;449(7162):564–9.
  21. Imperatore N, Castiglione F, Rispo A, Sessa A, Caporaso N, Morisco F. Timing strategies of direct-acting antivirals and biologics administration in HCV-infected subjects with inflammatory bowel diseases. Front Pharmacol. 2017;8:6–11.
  22. Sun H, Zhang J, Zhang H, Zou Z, Wang F, Jia J. Increased Th17 cells contribute to disease progression in patients with HBV-associated liver cirrhosi. J Viral Hepat. 2012;19(6):396–403.
  23. Aboobacker S, Kurn H, Al Aboud A. Secukinumab. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. p. 1–15. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537091/
  24. Chiricozzi A, Gisondi P, Bellinato F, Girolomoni G. Immune Response to Vaccination in Patients with Psoriasis Treated with Systemic Therapies. Vaccines (Basel). 2020;8(4):769–72.
  25. Svedbom A, Mallbris L, Larsson P, Nikamo P, Wolk K, Kjellman P, et al. Long-term Outcomes and Prognosis in New-Onset Psoriasis. JAMA Dermatol. 2021;157(6):1–8.

How to Cite

Ariani, L. N. A. W., Sudarsa, P. S. S., Sari, N. P. A. R. Y., Murti, N. I. K. ., & Utami, D. N. T. . (2023). Psoriasis vulgaris dengan anti-HCV reaktif yang diterapi injeksi secukinumab. Intisari Sains Medis, 14(2), 580–585. https://doi.org/10.15562/ism.v14i2.1648
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
0

Total
0

Share

Search Panel

Luh Nyoman Arya Wisma Ariani
Google Scholar
Pubmed
ISM Journal

Prima Sanjiwani Saraswati Sudarsa
Google Scholar
Pubmed
ISM Journal

Ni Putu Ayu Riska Yunita Sari
Google Scholar
Pubmed
ISM Journal

Nyoman Indra Karunia Murti
Google Scholar
Pubmed
ISM Journal

Desak Nyoman Trisepti Utami
Google Scholar
Pubmed
ISM Journal