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216:Oral Candidiasis Related to Interleukin-17A Inhibitor in Psoratic Patients. Report of Two Cases.[AAOM2020}
Poster Title: 216:Oral Candidiasis Related to Interleukin-17A Inhibitor in Psoratic Patients. Report of Two Cases.[AAOM2020}
Submitted on 29 Mar 2021
Author(s): PettasE1, Savva V1, TheofilouVI2, DaskalopoulosA1, GeorgakiM1, NikitakisNG
Affiliations: NikitakisNG11Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National & KapodistrianUniversity of Athens, Greece 2Department of Oncology & Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, USA
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
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Poster Information
Abstract: Background: Oral candidiasis (OC) is a common fungal infection, usually caused by Candida Albicans. OC exhibits a wide spectrum of clinical manifestations and is associated with immune dysregulation due to several local and systemic factors, including immunosuppressive or immunomodulatory drug side effects. Psoriasis is a common cutaneous disease of variable severity. In recent years, new systemic biologic agents have been used for treatment of psoriasis. Herein, we present two cases of OC related to interleukin-17A (IL-17A) inhibitors used for management of psoriasis.

Cases summary: Two female patients, 22 and 66 years old, respectively, presented for evaluation of red and white lesions affecting the oral mucosa. Both patients were treated with secukinumab, a monoclonal antibody against IL-17A, for cutaneous psoriasis. The clinical examination of the first patient revealed white plaques involving the dorsal tongue and palate; the lesions were partially removable leaving erythematous surface. With a provisional diagnosis of pseudomembranous candidiasis vs. leukoplakia, a cytology smear and an incisional biopsy were performed. The clinical examination of the second patient revealed erythematous lesions and removable white plaques on the buccal mucosa, dorsal tongue, hard palate and labial commissures. With a possible diagnosis of candidiasis, a cytologic examination was performed. In both cases, the microscopic findings were consistent with candidiasis. A final diagnosis of candidiasis related to IL-17A inhibitor was rendered. Both patients received antifungal therapy with complete resolution.

Conclusions: An intact and fully functional immune system plays a major role in the prevention of Candida infection; therefore, various medications with immunosuppressive or immunomodulatory effects place patients at risk for OC. Recent findings support an important role of IL-17 in protection against candida infections; in addition, patients with psoriasis or psoriatic arthritis on clinical trials with IL-17A inhibitors appear to be at increased risk for candida infection. Our cases support that psoriatic patients treated with such inhibitors should be at close monitoring for OC development and receive appropriate management.
Summary: To present two cases of oral candidiasis (OC) related to secukinumabuse for the management of psoriasis & establish the appropriate diagnostic work-up and treatment that those individuals should receive.

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References: 1. Gaffen SL, Moutsopoulos NM. Regulation of host-microbe interactions at oral mucosal barriers by type 17 immunity. Sci Immunol. 2020;5:eaau4594.
2. Blauvelt A, Chiricozzi A. The Immunologic Role of IL-17 in Psoriasis and Psoriatic Arthritis Pathogenesis. Clin Rev Allergy Immunol. 2018;55:379-390.
3. Saunte DM, Mrowietz U, Puig L, Zachariae C. Candida infections in patients with psoriasis and psoriatic arthritis treated with interleukin-17 inhibitors and their practical management. Br J Dermatol. 2017;177:47-62.
4. Puel A, Cypowyj S, Bustamante J, Wright JF, Liu L, Lim HK, Migaud M, Israel L, Chrabieh M, Audry M, Gumbleton M, Toulon A, Bodemer C, El-Baghdadi J, Whitters M, Paradis T, Brooks J, Collins M, Wolfman NM, Al-Muhsen S, Galicchio M, Abel L, Picard C, Casanova JL. Chronic mucocutaneous candidiasis in humans with inborn errors of interleukin-17 immunity. Science. 2011;332:65-8.

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