Severe candidal balanoposthitis on concurrent treatment with secukinumab and the antidiabetic agent empagliflozin (sodium‐glucose cotransporter 2 inhibitor – SGLT2‐inhibitor)

Moldenhauer, Ines; Pliquett, Rainer U.; Kreft, Burkhard; Sunderkötter, Cord

doi:10.1111/ddg.13807

Cited by 5 publications

(4 citation statements)

References 8 publications

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“…Besides clinical trials, the number of case series and reports specifically addressing the development of OC in patients receiving anti-IL17A regimens remains very limited [ 27 , 58 , 59 , 60 , 61 , 62 ]. In this regard, our three cases represent uncommonly reported examples of microscopically proven OC with the characteristic clinical appearance in patients without any other predisposing factor besides anti-IL17A treatment, while case #3 is the first well-documented OC related to brodalumab published to this date.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent antipsoriatic treatment with ixekizumab caused a relapse of the OC (without concomitant lichenoid lesions) within a month, which was successfully managed with fluconazole; no further recurrences occurred despite the continuation of the ixekizumab for the next 9 months. Finally, Moldenhauer et al [ 62 ] reported a 59-year-old male patient with psoriasis and psoriatic arthritis who developed candidal balanoposthitis, angular cheilitis, and OC (in the form of only partially removable pseudomembranous patches), in addition to labial and tongue swelling, while on secukinumab treatment (150 mg every 4 weeks) for the last 8 weeks. Notwithstanding, a clear relationship between Candida infection and secukinumab could not be safely claimed, as the patient was also under treatment with empagliflozin (SGLT-2 inhibitor) for diabetes type 2, another medication commonly associated with genital Candida infections mainly in women (vulvovaginal) [ 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…In relation to the possible need for drug discontinuation, it seems that OC does not necessarily constitute a reason to discontinue the anti-IL17A inhibitors, as in the case reported by Farah [ 60 ]. However, in the other four reported cases [ 27 , 58 , 61 , 62 ], discontinuation of the treatment was elected, followed by adjustment of the dosage [ 58 ] or replacement of the medication with other of the same [ 27 ] or other class [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

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Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

et al. 2021

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An intact and fully functional immune system plays a crucial role in the prevention of several infectious diseases. Interleukin (IL)17 is significantly involved in oral mucosa immunity against several antigens and microorganisms, including Candida albicans (CA). Herein, we present three cases of oral candidiasis (OC) related to the use of an IL17A inhibitor for psoriasis. Three psoriatic individuals presented for evaluation of widespread symptomatic oral lesions temporally correlated with the onset of IL17A inhibitors (secukinumab in two patients and brodalumab in one patient). Clinical examination revealed either partially removable white plaques in an erythematous background (case #1) or diffuse erythematous lesions (cases #2 and 3) involving several areas of the oral mucosa. Cytology smear, accompanied by histopathologic examination in case #1, confirmed the clinical impression of OC in all three cases. All patients received antifungal therapy with satisfactory clinical response. No discontinuation of the antipsoriatic regimen was recommended, but all patients were advised to remain under monitoring for possible OC relapses. During the last few years, new systemic biologic agents targeting IL17 have been used for the management of variable immune-mediated diseases. Few clinical trials and scarce case reports have shown that these medications place individuals at high risk of developing candidiasis. We propose that patients treated with these medications should be at close monitoring for the development of OC and, if it occurs, receive appropriate management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

et al. 2021

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“…For example, a recent report by Bartolo et al [ 73 ] showed the development of balanitis due to C. albicans and subsequent candidemia but also the potential role of other species such as C. glabrata . A severe form of balanoposthitis caused by C. albicans after treatment with SGLT2 was also described in a 57-year-old with type 2 diabetes coupled with oral candidiasis[ 74 ]. Of note, balanitis is rarely seen in circumcised males, as the moist space beneath the foreskin represents an ideal environment for facilitated yeast proliferation[ 4 ].…”

Section: Types Of Urogenital Candidiasis In Patients With Diabetesmentioning

confidence: 99%

Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review

Talapko¹,

Meštrović²,

Škrlec³

2022

World J Diabetes

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Both diabetes and fungal infections contribute significantly to the global disease burden, with increasing trends seen in most developed and developing countries during recent decades. This is reflected in urogenital infections caused by Candida species that are becoming ever more pervasive in diabetic patients, particularly those that present with unsatisfactory glycemic control. In addition, a relatively new group of anti-hyperglycemic drugs, known as sodium glucose cotransporter 2 inhibitors, has been linked with an increased risk for colonization of the urogenital region with Candida spp., which can subsequently lead to an infectious process. In this review paper, we have highlighted notable virulence factors of Candida species (with an emphasis on Candida albicans ) and shown how the interplay of many pathophysiological factors can give rise to vulvovaginal candidiasis, potentially complicated with recurrences and dire pregnancy outcomes. We have also addressed an increased risk of candiduria and urinary tract infections caused by species of Candida in females and males with diabetes, further highlighting possible complications such as emphysematous cystitis as well as the risk for the development of balanitis and balanoposthitis in (primarily uncircumcised) males. With a steadily increasing global burden of diabetes, urogenital mycotic infections will undoubtedly become more prevalent in the future; hence, there is a need for an evidence-based approach from both clinical and public health perspectives.

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Empagliflozin/secukinumab

2020

Reactions Weekly

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Severe candidal balanoposthitis on concurrent treatment with secukinumab and the antidiabetic agent empagliflozin (sodium‐glucose cotransporter 2 inhibitor – SGLT2‐inhibitor)

Cited by 5 publications

References 8 publications

Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

Oral Candida Infection in Psoriatic Patients Treated with IL17A Inhibitors: Report of 3 Cases and a Comprehensive Review of the Literature

Growing importance of urogenital candidiasis in individuals with diabetes: A narrative review

Empagliflozin/secukinumab

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