Acute Myocarditis During a Generalized Pustular Psoriasis Flare: A Possible Pharmacogenetic Interaction in the Setting of Severe Systemic Inflammation?

We report a case of acute myocarditis in a 25-year-old man with refractory generalized pustular psoriasis (GPP) following treatment with spesolimab, an anti-IL-36 receptor monoclonal antibody. Cardiac magnetic resonance fulfilled the Lake-Louise criteria for myocarditis, and genetic testing revealed a heterozygous pathogenic/likely pathogenic MYH7 variant, suggesting a possible gene-environment-drug interaction. The patient was managed with supportive care and presented no complications. In outpatient evaluation, the patient has remained asymptomatic with no further hospital admissions. This case underscores the need for vigilance regarding cardiac adverse events during IL-36 blockade and highlights the potential role of genetic predisposition in modulating susceptibility to myocardial injury.