Keywords
Ulcerative Colitis
Inflammatory Bowel Disease
IL-23/IL-17 Axis
Methotrexate
Clinical Diagnosis
Categories
Abstract
Background: Psoriasis and inflammatory bowel disease (IBD) share genetic susceptibility (IL23R, TYK2 loci) and immune activation of the IL-23/IL-17 axis, presenting a clinical overlap that poses a complex diagnostic and therapeutic challenge. Case Report: We report a 64-year-old male with chronic psoriasis treated with methotrexate who presented with recurrent hematochezia and abdominal pain, with mucosal activity confirmed by an elevated fecal calprotectin (152.2 µg/g). Colonoscopy revealed erosive ileopathy and moderate ulcerative pancolitis (Mayo II, Montreal E3S2), and histology confirmed active chronic ulcerative ileocolitis (Vienna 1). Discussion: Concomitant IBD formally contraindicates the use of IL-17 inhibitors for psoriasis due to the risk of inducing paradoxical intestinal flares, necessitating a strategic shift toward shared, safe molecular targets for both tissues, such as anti-TNF agents or IL-12/23 blockers (ustekinumab).
References
Freuer D, Linseisen J, Meisinger C. Association Between Inflammatory Bowel Disease and Both Psoriasis and Psoriatic Arthritis: A Bidirectional 2-Sample Mendelian Randomization Study. JAMA Dermatol. 2022;158(11):1262–1268. doi:10.1001/jamadermatol.2022.3682
Navarro-Compán V, Puig L, Vidal S, Ramírez J, Llamas-Velasco M, Fernández-Carballido C, Almodóvar R, Pinto JA, Galíndez-Aguirregoikoa E, Zarco P, Joven B, Gratacós J, Juanola X, Blanco R, Arias-Santiago S, Sanz Sanz J, Queiro R, Cañete JD. The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases. Front Immunol. 2023 Aug 4;14:1191782. doi: 10.3389/fimmu.2023.1191782. Erratum in: Front Immunol. 2023 Nov 22;14:1332177. doi: 10.3389/fimmu.2023.1332177. PMID: 37600764; PMCID: PMC10437113.
Guo J, Luo Q, Li C, et al. Evidence for the gut-skin axis: Common genetic structures in inflammatory bowel disease and psoriasis. Skin Res Technol. 2024; 30:e13611. https://doi.org/10.1111/srt.13611
Jauregui W, Abarca YA, Ahmadi Y, Menon VB, Zumárraga DA, Rojas Gomez MC, Basri A, Madala RS, Girgis P, Nazir Z. Shared Pathophysiology of Inflammatory Bowel Disease and Psoriasis: Unraveling the Connection. Cureus. 2024 Sep 3;16(9):e68569. doi: 10.7759/cureus.68569. PMID: 39364475; PMCID: PMC11449469.
Tabbarah S, Sulaiman H, Ansah Owusu F, Rajeev Joshi M, Marepalli NR, Pino N, Saleem Azam S, Ali Ahmed A, Abraham Suárez Álvarez J. Shared Pathophysiology of Inflammatory Bowel Disease and Psoriasis: Unraveling the Connection. Cureus. 2024 Sep 25;16(9):e70148. doi: 10.7759/cureus.70148. PMID: 39463646; PMCID: PMC11506146.
Hedin, C. R. H., Sonkoly, E., Eberhardson, M., & Ståhle, M. (2021). Inflammatory bowel disease and psoriasis: Modernizing the multidisciplinary approach. Journal of Internal Medicine, 290(2), 257–278. https://doi.org/10.1111/joim.13282
Layadi, E. B., Pribadi, R. R., Krisnuhoni, E., Kartika, E., Wijaya, F. W., & Ichsan, O. (2022). Ulcerative Colitis as the Rarer Phenotype of Inflammatory Bowel Disease to Coexist with Psoriatic Arthritis: A Case Report. Acta medica Indonesiana, 54(4), 614–620. - https://pubmed.ncbi.nlm.nih.gov/36624722/
Pan, J., Lv, Y., Wang, L., Chang, X., Zhao, K., & Liu, X. (2024). Mendelian randomization analysis of psoriasis and psoriatic arthritis associated with risks of ulcerative colitis. Skin research and technology : official journal of International Society for Bioengineering and the Skin (ISBS) [and] International Society for Digital Imaging of Skin (ISDIS) [and] International Society for Skin Imaging (ISSI), 30(7), e13795. https://doi.org/10.1111/srt.13795 (Retraction published Skin Res Technol. 2025 Oct;31(10):e70241. doi: 10.1111/srt.70241.) - https://pmc.ncbi.nlm.nih.gov/articles/PMC11242227/
Bautista-Molano, W., Ibatá, L., Martínez, S., & Chacón, A. (2024). Burden of Disease in Psoriatic Arthritis in Latin America: a Systematic Literature Review. Clinical rheumatology, 43(2), 677–693. https://doi.org/10.1007/s10067-023-06838-8 - https://pubmed.ncbi.nlm.nih.gov/38114817/
Zohar, A., Cohen, A.D., Bitterman, H. et al. Gastrointestinal comorbidities in patients with psoriatic arthritis. Clin Rheumatol 35, 2679–2684 (2016). https://doi.org/10.1007/s10067-016-3374-y - https://sci-hub.hlgczx.com/10.1007/s10067-016-3374-y#gsc.tab=0
Sun, Y., Li, Y. & Zhang, J. The causal relationship between psoriasis, psoriatic arthritis, and inflammatory bowel diseases. Sci Rep 12, 20526 (2022). https://doi.org/10.1038/s41598-022-24872-5 - https://www.nature.com/articles/s41598-022-24872-5
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Copyright (c) 2026 Bryan Harold Astudillo Ramirez, Tannia Estefanía Aguirre Soria, Daniela Alejandra Vega Albuja, Cristhian Alexander Velásquez Polanco, Andrea Cecilia Lara Grados