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Diffuse alveolar hemorrhage associated with ustekinumab treatment
Kulothungan Gunasekaran1, Anant Shukla2, Nageshwari Palanisamy3
1Division of Pulmonary Diseases and Critical Care, Yale-New Haven Health Bridgeport Hospital, Bridgeport, CT, USA.
Summary
A rare case of diffuse alveolar hemorrhage (DAH) occurred in a patient treated with ustekinumab for psoriatic arthritis. Prompt diagnosis and discontinuation of ustekinumab led to symptom resolution.
Area of Science:
- Pulmonology
- Rheumatology
- Immunology
Background:
- Ustekinumab is an interleukin-12/23 inhibitor used for treating psoriatic arthritis.
- Diffuse alveolar hemorrhage (DAH) is a serious pulmonary complication characterized by bleeding into the lung alveoli.
Observation:
- A 46-year-old female developed flu-like symptoms and hemoptysis one week after initiating ustekinumab for psoriatic arthritis.
- Chest CT revealed bilateral ground-glass opacities, and bronchoscopy showed progressively bloody bronchoalveolar lavage (BAL) fluid.
- BAL fluid analysis demonstrated over 90% hemosiderin-laden macrophages, indicative of DAH.
Findings:
- Infectious etiologies and common vasculitis conditions were excluded.
- A diagnosis of ustekinumab-induced DAH was established based on the temporal relationship and absence of alternative causes.
- This represents the first reported case of DAH associated with ustekinumab therapy in a patient with psoriatic arthritis.
Implications:
- This case highlights a rare but significant adverse reaction to ustekinumab.
- Awareness of ustekinumab-induced DAH is crucial for timely diagnosis and management.
- Discontinuation of ustekinumab and supportive care resulted in symptom improvement.
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