PMC9809383_01
Pathological images. Pathological results showed hyperkeratosis, confluent parakeratosis, Munro microabscesses, acanthosis hypertrophy, regular elongation of the rete ridges, mild spongiosis, papillary dermal edema, mildly dilated blood vessels, scattered perivascular lymphocytes, and neutrophils infiltrated around the upper epidermis and superficial dermis (HE, A x40, B x100, C x200).
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The pathological manifestations indicated hyperkeratosis, confluent parakeratosis, Munro microabscesses, acanthosis hypertrophy, regular elongation of the rete ridges, papillary dermal edema, mildly dilated blood vessels, scattered perivascular lymphocytes, and neutrophils infiltrated around the upper epidermis and superficial dermis (Figure 1), which are typical characteristics of erythrodermic psoriasis.
MRI images of the cervical spine. (A) MRI of the spine and Hip joint on April 8, 2020 indicated degeneration of the cervical vertebrae, abnormal changes in the bilateral sacroiliac and Hip joints with slightly swollen surrounding soft tissues, and swelling of the right obturator externus muscle. These were considered inflammatory lesions. (B) Image of the spine and Hip joint MRI on April 25, 2022 showed straightened physiological curvature of the cervical spine compared with the MRI results on April 8, 2020 before the use of biologics, with less severe bilateral sacroiliac joint inflammation.
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On April 8, 2020, the results of the spine and hip joint MRI performed in another hospital (Figure 2A) suggested abnormal changes in the bilateral sacroiliac and hip joints, slight swelling of the surrounding soft tissue, and right external obturator muscle swelling. On May 5, 2020, he was admitted to our hospital again and diagnosed with psoriatic arthritis (involvement of axial joints) and psoriasis vulgaris (Figure 2B).
Etanercept treatment photographs. (A) At the beginning of etanercept treatment (The patient's trunk has large areas of erythema, plaque, and tiny scales), (B) at the third week of etanercept treatment (Erythema area decreases and color fades), and (C) at the 21st week of etanercept treatment (The patient has a small area of pale erythema on his back).
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The psoriasis area and severity index (PASI) score of the skin lesion was 14.4 (Figure 3A), and the Disease Activity Index for Psoriatic Arthritis (DAPSA) score was 52. After three weeks, erythema and scales were significantly ameliorated (Figure 3B). The rash largely resolved after 21 weeks (Figure 3C), and the PASI score was 1.4.
Secukinumab treatment photographs. (A) At the beginning of secukinumab treatment (Erythema, plaque and thin scale are widely distributed on the trunk and extremities), (B) at the second week of secukinumab treatment (The erythema color fades, the plaque becomes thinner, and the scale decreases), (C) at the eighth week of secukinumab treatment (The skin rash on the trunk and upper limbs has basically subsided, and the lower limbs are widely distributed with light erythema, plaque and scales), (D) at the 29th week of secukinumab treatment (The rash is completely cleared) and (E) at the 34th week of secukinumab treatment (The rash is completely cleared).
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After 2 months, the rash recurred and worsened (Figure 4A). The times to achieve PASI 40, PASI 75, PASI 90, and PASI 100 were 2 weeks (Figure 4B), 4 weeks, 8 weeks (Figure 4C), and 29 weeks (Figure 4D), respectively. At present, secukinumab has been maintained for 1 year, and the clinical symptoms of psoriasis have stabilized (Figure 4E and the specific treatment timeline is shown in Figure 5).
Treatment timeline.
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At present, secukinumab has been maintained for 1 year, and the clinical symptoms of psoriasis have stabilized (Figure 4E and the specific treatment timeline is shown in Figure 5).