Transverse myelitis following guselkumab treatment for severe plaque psoriasis

We present a case of a man in his 40s with severe plaque psoriasis treated with guselkumab who developed bilateral lower extremity numbness and whose MRI demonstrated an acute contrast-enhancing demyelinating lesion in his cervical spine. The patient's neurologic symptoms improved significantly following discontinuation of the biologic agent with concurrent treatment of intravenous methylprednisolone. Naranjo score of 6, indicating probable adverse drug reaction, further supports this finding. This case marks the first reported instance of transverse myelitis in a patient receiving guselkumab. Greater awareness of this potential adverse event is suggested prior to starting this treatment, particularly in patients with evidence of demyelinating lesions in their central nervous system. Additional studies are needed to evaluate the safety of guselkumab in these patients. We provide a review of psoriasis treatments and highlight those that have been shown to exacerbate neuroinflammatory conditions, like multiple sclerosis, which can lead to attacks of demyelination.