Abstract

A 44-year-old male with a history of psoriasis, non-alcoholic fatty liver disease, and tuberculosis (TB) developed psoriatic arthritis after discontinuing efalizumab due to its market withdrawal. He was treated with adalimumab and methotrexate, but after a year, his psoriasis worsened and TB reactivation was suspected, although later ruled out. Treatment was switched to etanercept, but optic neuritis developed, prompting a change to ustekinumab, which controlled his psoriatic arthritis for 8 years. In 2019, he developed neurological symptoms suggestive of demyelinating disease, leading to a switch to guselkumab, resulting in clinical remission. This case illustrates the challenges in managing psoriasis with biologics in patients with comorbidities and the importance of monitoring for adverse effects and comorbidities.