Ixekizumab

Abstract

Cardiac sarcoidosis: case report A 58-year-old man developed cardiac sarcoidosis during treatment with ixekizumab for psoriasis. The man presented with one week’s history of dyspnoea. He had been receiving losartan for hypertension. Six weeks prior to the presentation, he started receiving SC ixekizumab 80mg every 4 weeks for psoriasis. His examinations showed arterial fibrillation with ejection fraction (EF) of 20-25%. However, his CT scan was non-significant. He received electrical cardioversion and discharged from the hospital. However, one day after cardioversion, his dyspnoea was worsened. Therefore, he was presented again. At that time, he was receiving metoprolol and rivaroxaban. His physical exam showed sinus tachycardia and bilateral pitting oedema. Also, his brain natriuretic peptide was increased to 3066 pg/mL. Subsequently, his chest CT scan showed mediastinal/hilar lymphadenopathy with scattered pulmonary nodules. Two months later, during follow up his echocardiogram showed a reduced EF of 43%, left atrial volume of 58 ml/m2 with grade-III diastolic dysfunction and mild mitral and tricuspid regurgitation. Subsequently, he underwent cardiac MRI, which showed mid-wall fibrosis predominantly in the basal septum. From the findings of cardiac MRI, it was suspected that he had potential sarcoidosis. Therefore, the diagnosis of cardiac sarcoidosis was confirmed on (18)Ffluorodeoxyglucose positron emission tomography. Thereafter, the man’s treatment with ixekizumab was stopped. As he was stable, the unspecified steroids were deferred. Subsequently, he was discharged from the hospital. During follow up after 6 weeks, he had no new symptoms, however, his echocardiogram showed EF of 20% and atrial fibrillation. Therefore, he was re-hospitalised and received IV unspecified steroids and maintained on prednisone. Then, he underwent cardioversion and was started on amiodarone. Later, he was discharged from the hospital with a stable condition.