Secukinumab-induced paradoxical skin lesions,but successful treatment with tofacitinib in SAPHO syndrome: a case report

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare autoinflammatorydisorder without standardized therapy. IL-17 inhibitors have been effective in individual cases. However, some patients with SAPHO may develop psoriasiform or eczematous lesions as a paradoxical side of treatment with biologics. We describe a patient with both secukinumab-induced paradoxical skin lesions and primary SAPHO syndromefor whom tofacitinib treatment led to rapid remission. A 42-year-old man with SAPHO developed paradoxical eczematous lesionsafter 3 weeks of secukinumab treatment. He then received tofacitinib treatment, which resulted in a rapid improvement in his skin lesions and osteoarticular pain. Tofacitinib might be a good treatment option for patients with SAPHO syndrome who exhibit secukinumab -induced paradoxicalskin lesions.