Abstract |
A 72-year old woman, who had a history of psoriasis and psoriatic arthritis from age of 69, was admitted because of acute progression of dyspnea and generalized muscle weakness after initiation of ustekinumab. She had been diagnosed as having lung and eye sarcoidosis ten months before admission. Nerve conduction studies revealed multiple mononeuropathy and needle electromyography showed myogenic changes with spontaneous activities. Muscle pathology showed non-caseating epithelioid granuloma and high expression of HLA-class I in myofibers. Diagnosis of sarcoid myopathy and neuropathy aggravated by ustekinumab was made, and ustekinumab administration was discontinued, resulting in slight improvement of her respiratory and neuro-muscular symptoms, but her symptoms remained severely disabled. Treatment with oral steroids further improved her clinical symptoms and she became able to walk independently. We considered that ustekinumab inhibited IL-12 and IL-23 signaling, which caused an imbalance in Th1/Th17 differentiation and activation of Th1 cell differentiation, thereby promoting the development of sarcoid myopathy and neuropathy.
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Authors | Hironori Sano, Toshihiko Maeda, Ryota Sato, Fumitaka Shimizu, Michiaki Koga, Takashi Kanda |
Journal | Rinsho shinkeigaku = Clinical neurology
(Rinsho Shinkeigaku)
Vol. 62
Issue 6
Pg. 475-480
(Jun 24 2022)
ISSN: 1882-0654 [Electronic] Japan |
PMID | 35644583
(Publication Type: Case Reports, Journal Article)
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Chemical References |
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Topics |
- Aged
- Female
- Granuloma
(pathology)
- Humans
- Myositis
(drug therapy)
- Peripheral Nervous System Diseases
(chemically induced, drug therapy)
- Psoriasis
(drug therapy)
- Sarcoidosis
(complications, diagnosis, drug therapy)
- Ustekinumab
(adverse effects)
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