Rapid remission of psoriasis with reversible leucopenia after two injections with adalimumab

Abstract

Conflict of interest: none declared. About 20% of patients with psoriasis have severe disease that requires systemic treatment. New forms of treatment such as tumour necrosis factor (TNF)‐α blockers provide a highly targeted approach, thus fewer systemic side‐effects are expected during the course of treatment. However, due to common systemic premedication, laboratory changes may deteriorate during the course of treatment. We report a 34‐year‐old man who developed leucopenia after treatment with adalimumab for severe plaque psoriasis and psoriatic arthritis (Fig. 1a). Leucopenia occurred after two injections of adamimumab 40 mg (Humira®; Abbott Gmbh, Wiesbaden, Germany) given with an interval of 1 week. The patient’s leucocyte level dropped from 3.68 × 109/L to 2.38 × 109/L (normal range 4–11 × 109/L), and neutropenia developed (0.89 × 109/L; normal range 1.5–7 × 109/L). Mild leucopenia (3–4 × 109/L) had been seen previously and was probably related to the long list of previous systemic medications the patient had been taking, which included fumaric acid, leflunomide, methotrexate, ciclosporin and etanercept. Either these treatments had failed to improve his skin or the patient had been unable to tolerate them. The most recent treatment (etanercept) had been discontinued about 9 months before starting adalimumab. Leucocyte levels had been stable for about 12 months at a level of 3–4 × 109/L.