Apremilast as a novel therapeutic option for psoriasis coexisting primary sclerosing cholangitis and ulcerative colitis: A case report

RATIONALE: Plaque psoriasis, primary sclerosing cholangitis, and ulcerative colitis are all immune-mediated inflammatory diseases. Their coexistence is extremely rare, and therapeutic management remains challenging due to shared immunopathogenic mechanisms and limited treatment experience. PATIENT CONCERNS: A 36-year-old woman presented with pruritic red papules and plaques covering scales all over the body for more than 10 years. She also reported liver dysfunction for over 3 years and chronic diarrhea exceeding 1 year. DIAGNOSES: Based on her medical history, clinical manifestations, histopathological findings, and examinations, she was diagnosed with plaque psoriasis, primary sclerosing cholangitis, and ulcerative colitis. INTERVENTIONS: The patient had shown an inadequate response to oral steroids and adalimumab. Upon presentation to our clinic, she was assessed as having moderate plaque psoriasis (Psoriasis Area and Severity Index: 6.0, body surface area: 10.0%) and was treated with oral apremilast (titrated up to 60 mg/d), ursodeoxycholic acid (1000 mg/d), and phosphatidylcholine (1368 mg/d). OUTCOMES: After 48 weeks of treatment, the patient achieved complete clearance of psoriatic lesions, marked reduction of pruritus, stable liver function, decreased diarrhea frequency, and no adverse events. LESSONS: This case underscores the potential response and tolerability of apremilast as an alternative treatment for psoriasis coexisting with autoimmune liver disease and inflammatory bowel disease.