The Administration of Tocilizumab to a COVID-19 Patient with Psoriasis Vulgaris – A Case Report

A case of male patient admitted to a hospital with bilateral pneumonia caused by COVID-19 is presented. It was found on admission that the patient had had psoriasis vulgaris; the patient had no therapy for six years and he had no regular checkups. Due to progression and high CT scan severity score and elevated serum IL-6, the decision was made to administer the patient tocilizumab. Upon administration, psoriatic lesions were in retreat. Even though there are some reports describing tocilizumab induced psoriasis, some studies have demonstrated a high level of IL-6 in psoriatic plaques. Therefore, therapies that disrupt IL-6 signaling could be a treatment option for psoriasis. Marija Branković1*, Igor Jovanović2, Tijana Radonjić2, Ilija Bukurecki2 and Marija Zdravković1 1University Hospital Medical Center Bezanijska Kosa, Serbia 2University of Belgrade, Serbia Marija Branković, et al., Clinical Case Reports International General Medicine Remedy Publications LLC., | http://clinicalcasereportsint.com/ 2021 | Volume 5 | Article 1226 2 as a marker of the inflammatory activity in psoriasis as well as an indicator of treatment response [2]. IL-6 is produced by a wide range of cell types in psoriatic plaques (including keratinocytes, fibroblasts, endothelial cells, DCs, and macrophages) in response to several stimuli, such as IL-1, TNF-α, IL-17 and IL-36 [2]. Tocilizumab is a humanized antihuman Interleukin-6 (IL-6) receptor antibody. It is an approved biologic medication for the treatment of rheumatoid arthritis. Several cases of tocilizumab induced psoriasis have been described do far. Studies about these Figure 1: Clinical images. Retreat of psoriatic lesions on lower leg and ankle (a), trunk (b, e), upper leg (c) and knee (c, d), and back (e). Figure 2: Images taken by the patient after 10 days of hospital discharge. Psoriatic lesions in relapse on lower leg (a, b, c), ankle (a), upper leg and knee (c), and lateral side of the abdomen (d). unwanted events imply that approximately ten to fifteen days after the induction dose of tocilizumab, psoriatic plaques developed (skin biopsies confirmed diagnosis) [3]. Tocilizumab-induced psoriasis was suspected and the treatment was stopped while the psoriatic lesions resolved quickly with corticosteroids [3]. One report showed that after the administration of intravenous tocilizumab, as a therapy for rheumatoid arthritis, psoriatic-like lesions developed (lesion biopsy was not performed because the patient’s consent was not obtained); however, on administration of subcutaneous tocilizumab on same patient, as higher doses of tocilizumab could be administered by subcutaneous injection rather than by intravenous injection, also shortening the dosing interval, psoriatic-like lesions improved [4]. On the other hand, there is a report about a young woman with juvenile idiopathic arthritis who was given etanercept but it induced psoriasiform skin lesions diagnosed by skin biopsy [5]. Because of this adverse reaction to etanercept, intravenous tocilizumab was induced in the therapy and four weeks later, an improvement was observed in the skin lesions [5]. Further, six months later, she was in clinical remission of JIA and the skin lesions had resolved [5].