Secukinumab-induced systemic lupus erythematosus occurring in a patient with ankylosing spondylitis
Louise Koller‐Smith, S. P. Oakley
Abstract
Dear Editor, We present a 40-year-old Caucasian male, diagnosed with HLA-B*27 negative ankylosing spondylitis in July 2016 after presenting with inflammatory back pain, raised inflammatory markers and bilateral grade 2 sacroiliitis. He commenced naproxen, then etanercept (a TNF-α inhibitor) in October 2016. He responded well until February 2018 when his pain recurred, and CRP increased to 46 mg/l. He was changed to the IL-17A inhibitor secukinumab 300 mg subcutaneously with weekly loading in March 2018. In April 2018, after two doses of secukinumab, the patient awoke with left-sided pleuritic chest pain, mild flu-like symptoms and a low-grade fever of 37.5°C. His heart rate was 110 per min, blood pressure 130/100 mmHg, respiratory rate 18 and O2 saturations 97%. His jugular venous pressure was elevated, but Kussmaul’s sign was negative. He had decreased breath sounds at the right lung base. An electrocardiogram showed widespread ST elevation and reciprocal ST...