Successful Psoriasis Management With Deucravacitinib After Guselkumab‐Associated Eosinophilic Pneumonia

ABSTRACT Eosinophilic pneumonia (EP) involves the accumulation of eosinophilic infiltrates in the lung parenchyma, potentially triggered by smoking, infections, or medications, including biologics for psoriasis. This case report describes a 49‐year‐old female with a history of psoriasis and chronic pancreatitis, who developed EP after initiating guselkumab, an IL‐23 inhibitor. Following a 4‐month hiatus from ustekinumab due to insurance issues, she received guselkumab for a psoriasis flare (60% BSA). Shortly before the second dose, she presented with pleuritic chest pain, cough, and shortness of breath. CT revealed extensive ground‐glass infiltrates, and bronchoscopy with bronchoalveolar lavage (BAL) showed 52% eosinophils, indicating EP. Two months postdischarge, follow‐up CT showed near‐complete resolution of opacities, and 4 months later, after tapering off of systemic corticosteroids, her psoriasis flared again (60% BSA). Due to EP and preference for a nonbiologic treatment, deucravacitinib, a TYK2 inhibitor, was initiated, resulting in well‐controlled psoriasis (BSA = 0%) after 3 months, with only mild, resolved acne. This case suggests deucravacitinib as a viable option for patients experiencing noninfectious pneumonia from prior biologic therapy and highlights the importance of monitoring for pulmonary symptoms in patients on biologics.