Golimumab-triggered Palmoplantar Pustular Psoriasis in Ankylosing Spondylitis: Case Study and Evidence Review

Abstract

Background: Golimumab, a human monoclonal antibody targeting tumor necrosis factor-alpha (TNF-α), is widely used to treat ankylosing spondylitis (AS). However, it can paradoxically trigger dermatological conditions, including psoriasis. This report details a rare instance of palmoplantar pustular psoriasis (PPP) induced by golimumab in an AS patient. Case Presentation: A 39-year-old male smoker with HLA-B27-positive axial AS (BASDAI 4.6, BASFI 5.6) began golimumab (50 mg monthly) in October 2022 after inadequate NSAID response. Ten months later, he developed PPP with pustules on the palms and soles, plus psoriatic plaques on the thighs and legs. Golimumab was stopped, and treatment shifted to secukinumab (an anti-IL-17 agent) with topical corticosteroids, resulting in significant lesion improvement within weeks and ongoing AS control. Conclusion: This case illustrates a rare paradoxical effect of golimumab, likely driven by altered immune regulation involving interferon-alpha (IFN-α) and IL-17 pathways. Discontinuing golimumab and initiating anti-IL-17 therapy was effective. Clinicians should monitor for skin-related side effects in AS patients on anti-TNF drugs, especially those with smoking history, and consider tailored therapeutic approaches. Further studies are needed to explore this phenomenon.