Control of porphyria cutanea tarda with anti-IL-17 secukinumab in a person with psoriasis living with HIV

A 65-year-old woman successfully treated for human immunodeficiency virus (HIV) and Hepatitis C virus was diagnosed with porphyria cutanea tarda (PCT) and treated by phlebotomies. She developed extensive psoriatic skin lesions resistant to topical treatments and methotrexate. She then received the anti-interleukin-17 (IL-17) secukinumab (Cosentyx) which improved her psoriatic skin lesions. Unexpectedly, her PCT skin lesions healed, allowing phlebotomy discontinuation over 2 years. Without lesions, the patient decided to discontinue secukinumab, leading to the recurrence of psoriatic and PCT skin lesions, which were controlled upon therapeutical rechallenge. No AIDS-related manifestations or infections developed, her CD4 count remained elevated and her HIV viral load was controlled under antiretroviral therapy. Both skin conditions and consequently the patient’s quality of life have improved with secukinumab, allowing exposure to sunlight and phlebotomy discontinuation for >4 years. Likely, the IL-17 pathway is involved in the clinical manifestations of PCT, opening new avenues for therapeutical interventions.