BG07 Three cases of biologic-associated interstitial lung disease

Abstract

Interstitial lung disease (ILD) is not a side effect of biologics recognized by dermatologists. It is not listed in patient information leaflets. We report three patients with psoriasis receiving biologic therapy who were diagnosed with drug-induced ILD by respiratory physicians. Case 1: a 74-year-old woman developed ILD while on ixekizumab (started 31 months prior – October 2020). She had previously been treated unsuccessfully with adalimumab (March 2019 to June 2020), secukinumab (June 2020 to October 2020), ixekizumab (October 2020 to January 2023 and May 2023 to January 2024) and ustekinumab (February 2023 to May 2023). She had a normal chest X-ray prior to biologic therapy. She had breast cancer treated with lumpectomy, radiation and hormone therapy in 2009 and 2022. Respiratory physicians had diagnosed chronic obstructive pulmonary disease in May 2019 and implicated ixekizumab in her new lung disease. She passed away from her ILD in April 2025. Case 2: a 72-year-old woman developed ILD while on adalimumab (commenced 4 years prior). She was previously treated with acitretin (September 2006 to March 2007), methotrexate (April 2007 to June 2019), ustekinumab (August 2018 to June 2019), adalimumab (June 2019 to December 2024) and secukinumab (December 2024 to present). She had a normal chest X-ray prior to biologic therapy. ILD was diagnosed in December 2024 and adalimumab was stopped; she now requires home oxygen. Case 3: a 66-year-old woman developed ILD while on guselkumab for plantar psoriasis. It was noticed incidentally on computed tomography investigating a shoulder injury. She was treated with adalimumab (November 2021 to April 2023), guselkumab (April 2023 to April 2024) and ixekizumab (April 2024 to present). Her lung changes have resolved and she was discharged. A 2025 publication from the VigiBase database showed that ILD was predominantly associated with tumour necrosis factor inhibitors, although causality could not be excluded. Case reports exist across IBD and respiratory literature, and controversy remains in rheumatology. Our cases highlight this contentious issue.