PMC7422905_01
Ocular conjunctival findings and skin lesions before the introduction of ustekinumab. Bilateral conjunctival congestion (A) and punctate erythema with desquamation in the forearm (B) and abdomen (C).
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On admission, she developed systemic punctate erythema with desquamation, polyarthralgia without redness and swelling, and hyperemia without ocular discharge on both bulbar conjunctiva (Figure 1).
MRI findings of the sacroiliac joints before and two months after the introduction of ustekinumab. (A) STIR-MRI image presents hyperintense foci in the bilateral sacroiliac joints, especially on the right side (arrows). (B) STIR-MRI image shows mild enhancement on the right side only (arrows). MRI-STIR, Short tau inversion recovery-magnetic resonance imaging.
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Short tau inversion recovery (STIR)-magnetic resonance imaging (MRI) of the sacroiliac joints revealed hyperintense foci in the bilateral sacroiliac joints, especially on the right side (Figure 2A). Two months after the start of ustekinumab therapy, STIR-MRI of the sacroiliac joints showed improvement in the white matter hyperintensities (Figure 2B), the ASDAS-CRP and BASDAI were significantly improved to 0.98 and 1.4, respectively, and the serum CRP level decreased to 1.39 mg/dL (Figure 4).
Complete resolution in the bilateral ocular conjunctiva (A), forearm (B), and abdomen (C) two months after one ustekinumab injection.
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Spondylitis Disease Activity Score (ASDAS)-CRP and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) at the start of ustekinumab therapy were 4.3 and 7.0, respectively. Shortly thereafter, arthritis, skin eruptions, and scleritis resolved (Figure 3), and the hip pain gradually improved.
ASDAS-CRP score, BASDAI, and CRP levels after treatment with ustekinumab.. Abbreviations: ASDAS, Ankylosing Spondylitis Disease Activity Score; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; CRP, C-reactive protein.
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Two months after the start of ustekinumab therapy, STIR-MRI of the sacroiliac joints showed improvement in the white matter hyperintensities (Figure 2B), the ASDAS-CRP and BASDAI were significantly improved to 0.98 and 1.4, respectively, and the serum CRP level decreased to 1.39 mg/dL (Figure 4).