Complex otologic infection in a patient under anti IL-17A therapy

A 27 year old patient presented herself suffering from therapy-refractory acute otitis with hearing loss, severe earache and incomplete lid closure. She further reported a history of ankylosing spondylitis, currently under treatment with Secukinumab. Otomicroscopy revealed swelling and blisters within the external auditory canal and a pale and thickened tympanic membrane. A CT-scan showed acute otitis media with reactive mastoiditis without desctruction of bony structures. PCR and serology revealed a reactivation of VZV. Initial treatment consisted of myringotomy,antiviral treatment with acyclovir, systemic antibiotics, and corticosteroids. After slow recovery, the patient was discharged after 14 days, Secucinumab was paused. More than 4 weeks later the patient presented herself again with othorrhea of the left ear. An MRI-Scan revealed acute mastoiditis for which mastoidectomy as well as systemic antibiotic and antimycotic treatment was necessary. After continued pausing of Secukinumab no further complications occurred.

We suggest that the effective suppression of IL-17A with Secukinumab lead to this biphasic and prolonged course disease based on its pharmacokinetics and mode of action. IL-17 A plays an essential role in T-cell based immune mechanisms and control of infections. This case can be used to showcase potential mechanisitic side effects of targeted biological therapy.

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Publication History

Article published online:
10 June 2020