A Case of Meningococcal and HSV-2 Meningitis in a Patient Being Treated with Ustekinumab for Pityriasis Rubra Pilaris
  • Charalampos I Kalogeropoulos
    Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
  • Konstantinos Papathanasiou
    Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
  • Ismini Tsagkaraki
    Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
  • Georgios Giannopoulos
    Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
  • Aristotelis Bamias
    Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
  • Eleni Boutati
    Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece

Keywords

Pityriasis rubra pilaris, ustekinumab, meningococcal meningitis

Abstract

Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory papulosquamous dermatosis affecting both adults and children. Six subtypes of PRP have been described. Recently, the management of PRP with biologic immunosuppressive agents regularly used in psoriasis has been supported by several case reports and series. Ustekinumab is an anti-IL12/23 IgG1 kappa human monoclonal antibody. It has been approved for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis and ulcerative colitis. It has also been reported to be effective as an off-label treatment for PRP. Current data are equivocal regarding infectious disease risk with ustekinumab administration. We describe a case of meningococcal and HSV-2 infection of the central nervous system in a patient being treated with ustekinumab for PRP.

VIEW THE ENTIRE ARTICLE

References

  • Klein A, Landthaler M, Karrer S. Pityriasis rubra pilaris: a review of diagnosis and treatment. Am J Clin Dermatol 2010;11(3):157–170.


  • Kromer C, Sabat R, Celis D, Mössner R. Systemic therapies of pityriasis rubra pilaris: a systematic review. J Dtsch Dermatol Ges 2019;17(3):243–259.


  • EMC. STELARA 45 mg and 90 mg, solution for injection (vials) and solution for injection in prefilled syringe. Summary of product characteristics. Available from: https://www.medicines.org.uk/emc/medicine/32569. Accessed 26 March 2020.


  • Wohlrab J, Kreft B. Treatment of pityriasis rubra pilaris with ustekinumab. Br J Dermatol 2010;163(3):655–656.


  • Chowdhary M, Davila U, Cohen DJ. Ustekinumab as an alternative treatment option for chronic pityriasis rubra pilaris. Case Rep Dermatol 2015;7(1):46–50.


  • Napolitano M, Lembo L, Fania L, Abeni D, Didona D, Didona B. Ustekinumab treatment of pityriasis rubra pilaris: a report of five cases. J Dermatol 2018;45(2):202–206.


  • Aragón-Miguel R, Prieto-Barrios M, Calleja-Algarra A, Velasco-Tamariz V, Andres-Lencin JJ, Ortiz-Romero P, et al. Refractory pityriasis rubra pilaris with good response after treatment with ustekinumab. J Dtsch Dermatol Ges 2018;16(8):1022–1025.


  • Papp K, Gottlieb AB, Naldi L, Pariser D, Ho V, Goyal K, et al. Safety surveillance for ustekinumab and other psoriasis treatments from the Psoriasis Longitudinal Assessment and Registry (PSOLAR). J Drugs Dermatol 2015;14(7):706–714.


  • Stöllberger C, Finsterer J. Varicella zoster virus meningitis under ustekinumab because of plaque psoriasis. J Dermatol 2017;44(6):703–705.


  • Van Den Tooren HK, Bharambe V, Silver N, Michael BD. Herpes simplex virus encephalitis in a patient receiving ustekinumab associated with extensive cerebral edema and brainshift successfully treated by immunosuppression with dexamethasone. BMJ Case Rep 2019;12(8).


  • Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician 2017;96(5):314–322.


  • Janssen Biotech, Inc. STELARA® (ustekinumab). Highlights of prescribing information. Available from http://www.stelarahcp.com/pdf/PrescribingInformation.pdf. Accessed 20 February 2020.


  • Sehgal VN, Pandhi D, Khurana A. Biologics in dermatology: adverse effects. Int J Dermatol 2015;54(12):1442–1460.


  • Winthrop KL, Mariette X, Silva JT, Benamu E, Calabrese LH, Dumusc A, et al. ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies: an infectious diseases perspective (Soluble immune effector molecules [II]: agents targeting interleukins, immunoglobulins and complement factors). Clin Microbiol Infect 2018;24:S21–40.


  • Tian C, Hromatka BS, Kiefer AK, Eriksson N, Noble SM, Tung JY, et al. Genome-wide association and HLA region fine-mapping studies identify susceptibility loci for multiple common infections. Nat Commun 2017;8(1):599.

    • Views: 1599
    HTML downloads: 148
    PDF downloads: 683

    Published: 2020-05-22
    Issue: 2020: Vol 7 No 8 (view)

    How to cite:
    1.
    Kalogeropoulos CI, Papathanasiou K, Tsagkaraki I, Giannopoulos G, Bamias A, Boutati E. A Case of Meningococcal and HSV-2 Meningitis in a Patient Being Treated with Ustekinumab for Pityriasis Rubra Pilaris. EJCRIM 2020;7 doi:10.12890/2020_001615.