Abstract
ABSTRACTEosinophilic pneumonia (EP) involves the accumulation of eosinophilic infiltrates in the lung parenchyma, potentially triggered by smoking, infections, or medications, including biologics for psoriasis. This case report describes a 49‐year‐old female with a history of psoriasis and chronic pancreatitis, who developed EP after initiating guselkumab, an IL‐23 inhibitor. Following a 4‐month hiatus from ustekinumab due to insurance issues, she received guselkumab for a psoriasis flare (60% BSA). Shortly before the second dose, she presented with pleuritic chest pain, cough, and shortness of breath. CT revealed extensive ground‐glass infiltrates, and bronchoscopy with bronchoalveolar lavage (BAL) showed 52% eosinophils, indicating EP. Two months postdischarge, follow‐up CT showed near‐complete resolution of opacities, and 4 months later, after tapering off of systemic corticosteroids, her psoriasis flared again (60% BSA). Due to EP and preference for a nonbiologic treatment, deucravacitinib, a TYK2 inhibitor, was initiated, resulting in well‐controlled psoriasis (BSA = 0%) after 3 months, with only mild, resolved acne. This case suggests deucravacitinib as a viable option for patients experiencing noninfectious pneumonia from prior biologic therapy and highlights the importance of monitoring for pulmonary symptoms in patients on biologics.
Published Version
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