SHM Converge Scientific Abstract ePoster Gallery-Guselkumab-Induced Diffuse Alveolar Hemorrhage: A Rare and Fatal Complication

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This case report describes a rare and fatal complication of guselkumab, an IL-23p19 inhibitor used to treat psoriasis and psoriatic arthritis. The authors note that diffuse alveolar hemorrhage (DAH) has been reported only rarely with this biologic, making this the second documented case in the literature.<br /><br />A 59-year-old woman with asthma and psoriatic arthritis, receiving monthly guselkumab injections, presented with one week of worsening shortness of breath and generalized weakness. She was found to have leukocytosis, lactic acidosis, and respiratory acidosis. Imaging showed bilateral ground-glass opacities on chest X-ray and CT, raising concern for DAH. Her respiratory status rapidly declined, requiring noninvasive ventilation and then mechanical ventilation. Bronchoscopy with bronchoalveolar lavage revealed progressively bloodier aliquots, confirming DAH. Infectious and autoimmune evaluations, including vasculitis testing, were negative, supporting guselkumab as the likely cause.<br /><br />Because of severe hypoxemia, she was treated with pulse-dose corticosteroids and required extracorporeal membrane oxygenation (ECMO) for one week. She initially improved and was weaned off oxygen, but her recovery was later complicated by ischemic bowel. Her condition worsened further, and she was ultimately transitioned to comfort care and died.<br /><br />The report emphasizes that although guselkumab is effective for moderate-to-severe psoriasis and psoriatic arthritis, clinicians should remain alert for rare but life-threatening pulmonary complications such as DAH. Early recognition, bronchoscopy, corticosteroids, and advanced respiratory support may be critical, but serious adverse events can still lead to poor outcomes.

Asset Subtitle

Mohammed Youssef

Meta Tag

Author List Mohammed Youssef, Mohan Philip, Sofiya Rehman, Zainab Javeed

Category Clinical Vignettes

Concept Guselkumab

Concept Diffuse Alveolar Hemorrhage

Concept IL-23 Inhibitor

Concept Progressive Exertional Dyspnea

Concept Ground-Glass Opacities

Distinguished Non-Finalist

Presenter Organization Hunt Regional Medical Center/ Arkansas College of Osteopathic Medicine

Presenting Author Mohammed Youssef

Track Adult

Keywords

guselkumab

diffuse alveolar hemorrhage

psoriatic arthritis

psoriasis

IL-23p19 inhibitor

ground-glass opacities

bronchoscopy

extracorporeal membrane oxygenation

corticosteroids

fatal complication

Guselkumab

Diffuse Alveolar Hemorrhage

IL-23 Inhibitor

Progressive Exertional Dyspnea

Ground-Glass Opacities