Ustekinumab in the Treatment of Guttate Psoriasis and Crohn's Disease: A Case Report

Abstract

Psoriasis and Crohn's disease are autoimmune diseases believed to share a similar pathogenesis. Ustekinumab is FDA-approved for treatment of psoriasis in 45 mg and 90 mg dosages and is undergoing phase III trials for Crohn's disease in higher dosages. Data on ustekinumab in guttate psoriasis (GP) are limited. We report the case of a 21-year-old female with Crohn's disease on adalimumab who developed severe, generalized GP 2 months after a streptococcal infection. Her GP did not regress after discontinuation of adalimumab. She began ustekinumab 45 mg every 12 weeks, which led to complete regression of her psoriasis. Due to persistent bowel symptoms, ustekinumab was increased to 135 mg every 8 weeks, with improvement. In this case, GP may have been related to recent streptococcal infection, or a complication of TNF-inhibitor therapy. Here, we show ustekinumab has potential as a therapeutic option for both GP and Crohn's disease.