Paradoxical Reaction and Parastomal Pyoderma Gangrenosum Emergence With Secukinumab Therapy

ABSTRACT Paradoxical reactions are characterized by the emergence or worsening of a pathological condition that typically responds to the administered drug while treating the patient for another condition. Certain drugs, such as tumor necrosis factor inhibitors, can induce pyoderma gangrenosum. Recently, the drug secukinumab has been implicated in a few case reports as a potential cause of pyoderma gangrenosum after initiation. We report the first case of biologic-refractory ulcerative colitis presenting with parastomal pyoderma gangrenosum after the initiation of secukinumab. While these associations are still being investigated, they highlight the importance of monitoring patients for possible adverse skin reactions when starting new medications.