Treatment of severe psoriasis with etanercept in a pancreas-kidney transplant recipient.

Severe psoriasis is a rare condition under immunosuppressive therapy. We describe a 42-years-old man with psoriasis since the age of 22 years. The patient underwent a combined pancreas-kidney transplantation at the age of 32 because of Goodpasture syndrome with renal and pulmonary involvments and type 1 diabetes mellitus. Seven years later a pancreas retransplantation was performed due to nonfunction of the original pancreas allograft. Despite intensive systemic immunosuppression, consisting of prednisone, tacrolimus, and mycofenolate mofetil, and topical treatment with dithranol and steroids, there was significant worsening of psoriasis. In October 2009 we initiated therapy with etanercept (25 mg s.c.) twice weekly under close clinical and laboratory monitoring. Improvement was rapid with a decrease in Psoriasis Area and Severity Index (PASI) from 25.2 to <5 during the first months of treatment without a severe infection or other adverse reaction. Graft functions were not affected by the treatment. The patient remains till now on the same regimen and is almost free of skin manifestations. To our knowledge so far only 2 cases of etanercept therapy in psoriasis have been reported in liver transplant recipients. In both cases the treatment was well tolerated and effective. Psoriasis therapy in organ transplant recipients represents a major challenge. Biological agents such as etanercept may provide an effective option for refractory cases.