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Eosinophilia during Psoriasis Treatment with TNF Antagonists

Patient 2 A 55-year-old Caucasian female with a 13-year history of plaque-type psoriasis and psoriatic arthritis had failed to show satisfactory results after receiving anthralin, topical steroids, calcineurin inhibitors, narrow-band UVB and psoralen + UVA. Combination treatment with adalimumab, anthralin and topical steroids was initiated. The complete blood count was normal. Over the next 11 months, the PASI fell from 7.7 to 0. After 8.5 months of therapy, she developed eosinophilia (1,250/ l, peaking at 1,480/ l; fig. 1 b). After 3.5 months, ECP was elevated (149  g/l). A parasite screen of a faecal specimen revealed asymptomatic colonization with the facultative pathogen Dientamoeba fragilis , which we decided not to treat [5] . The total blood IgE level was not elevated, and tryptase was slightly elevated (14.7 U/l). The haematological profile was normal. After a switch from adalimumab to methotrexate, the eosinophilia resolved within 10 days.