Inflammatory Bowel Diseases, 2022, 28, e47–e48 https://doi.org/10.1093/ibd/izab267 Advance access publication 18 November 2021 Letter to the Editor Multifaceted Secukinumab-induced Colitis Alexandros G. Sykaras, MD,∗ Evangelia Margellou, MD, † Natalia G. Vallianou, PhD, †, Fotis Panagopoulos, MSc, † Eleni Geladari, MSc, † Dimitris Kounatidis, MSc, † Ioannis Alevizakis, MD, ‡ and Christina Magkou, PhD∗ From the ∗Department of Pathology, Evangelismos Hospital, Ipsilantou 45-47, 106 46, Athens, Greece; † Department of Internal Medicine, Evangelismos Hospital, Ipsilantou 45-47, 106 46, Athens, Greece; ‡ Department of Surgery, Evangelismos Hospital, Ipsilantou 45-47, 106 46, Athens, Greece Address correspondence to: Natalia G. Vallianou, Department of Internal Medicine, Evangelismos Hospital, Ipsilantou 45-47, 106 46, Athens, Greece (natalia. vallianou@hotmail.com). Dear Editor, A thirty-year-old female patient presented to our hospital due to high fever (39°C), diffuse abdominal pain, vomiting and diarrhea, that had started fve days before. She had psoriasis for twenty-two years complicated with psoriatic arthritis during the last year, for which she had been treated with methotrex- ate and corticosteroids. Due to the lack of improvement of her symptoms, former treatment was replaced with biological fac- tors and she was administered a single dose of secukinumab two months before admission. On clinical examination, she had abdominal tenderness, fatulence and there was absence of sounds on auscultation. Her abnormal laboratory tests were hs- CRP: 46.3 mg/dL (normal values < 0.5 mg/dL), ESR: 66 mm/h, while abdominal X-ray and CT scan revealed perforation of the large bowel and the patient underwent emergency sub-total colectomy because of her life-threatening deterioration. Three sites of perforation, measuring from 1,2 to 4 cm, were recognized in the surgical specimen. Terminal ileum mucosa had a nodular appearance and the large intestinal mucosa was abnormal in all the segments; oedematous with nodular and patchy cobblestone appearance in the right colon, whereas the left colon’s mucosa was characterized by brown-coloured, fattened, granular-micronodular appearance and plenty of pseudopolyps with areas of mucosal bridging. Serosa ap- peared roughened and was partially covered with a fbrinous exudate in the transverse and the left colon. Histologically, there was moderate-severe active muco- sal infammation with extensive erosions and ulceration. A striking histologic feature was the presence of small blood vessels with infammation, thickened intima, occlusion of the vessel lumen and fbrinoid necrosis. Additional histological fndings (extensive edema with hemorrhage in lamina propria, marked distention and congestion of blood vessels, loss of epi- thelial crypts) suggested an ischemic pattern of injury (Figure 1). Based on macroscopic and microscopic fndings, we estab- lished a diagnosis of moderate-severe acute-active ileo-colitis, with extensive ulcerations and early signs of chronicity. Given the clinical history, we believe that this should be classifed as © The Author(s) 2021. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com FIGURE 1. Histological features of secukinumab-induced colitis. (A) Moderate-severe active mucosal inflammation with extensive erosions-ulceration and presence of cryptitis- cryptic abscesses. (B) Inflammation and fibrinoid necrosis of the wall of blood vessels with occlusion of their lumen were also observed. Downloaded from https://academic.oup.com/ibdjournal/article/28/4/e47/6430981 by guest on 10 October 2023