Severe acute toxoplasmosis infection following ustekinumab treatment in a patient with psoriasis vulgaris

A 26-year-old man undergoing therapy with 45 mg ustekinumab (Stelara) for chronic psoriasis vulgaris was referred by his general practitioner to an infectious diseases department for fatigue, fever, night sweating, generalised lymphadenomegaly and unexplained weight loss. Physical examination reveal...

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Bibliographic Details
Published inBMJ case reports Vol. 12; no. 8; p. e230415
Main Authors Muslimani, Muhammad A, Di Palma-Grisi, James
Format Journal Article
LanguageEnglish
Published England BMJ Publishing Group LTD 01.08.2019
BMJ Publishing Group
SeriesCase Report
Subjects
Acute Disease
Adult
Arthritis
Autoimmune diseases
Case reports
Contrast agents
Dendritic cells
Dermatologic Agents - adverse effects
Hematology
Humans
Immunotherapy
Infections
Infectious diseases
Lymphatic system
Lymphoma
Male
Medical imaging
Monoclonal antibodies
Patients
Psoriasis
Psoriasis - drug therapy
Psoriasis - microbiology
Skin cancer
Toxoplasma
Toxoplasmosis - chemically induced
Tropical diseases
Ultrasonic imaging
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
Ustekinumab - adverse effects
immunological products and vaccines
infections
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Summary:A 26-year-old man undergoing therapy with 45 mg ustekinumab (Stelara) for chronic psoriasis vulgaris was referred by his general practitioner to an infectious diseases department for fatigue, fever, night sweating, generalised lymphadenomegaly and unexplained weight loss. Physical examination revealed bilateral occipital, cervical, axillary and inguinal lymphadenomegalies in addition to splenomegaly. Preliminary investigation revealed elevated Plasmodium lactate dehydrogenase and an inversion of the CD4/CD8 ratio. Whole-body spiral CT scanning with and without contrast showed splenomegaly and highlighted supradiaphragmatic and subdiaphragmatic lymphadenopathies. A complete Infectious Disease Test Panel revealed high levels of anti-Toxoplasma gondii antibodies. Immunoglobulin G avidity was negative. Peripheral blood lymphocyte phenotyping was performed to exclude underlying lymphatic neoplasia. The diagnosis of severe acute toxoplasmosis infection in the setting of immune response modifiers was made. Ustekinumab was suspended indefinitely and the patient underwent monthly serological tests to monitor the immune response until all symptoms resolved and the serological testing was negative for Toxoplasma.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-230415