Consent was obtained, and a monitoring strategy was agreed by patient and treating physician. Informed consent: he had given the authors permission to publish this case report. Discussion Autoimmune hemolytic anemia is common conditions found in clinical practice, despite the elaboration and diagnosis of the etiology remain a challenge for clinicians. are being investigated for their potential application in the treatment of psoriatic arthritis. One of the routes identified as a potential therapeutic target for psoriatic arthritis is the interleukin-17A inflammatory cytokine pathway (IL-17A) . The IL-17 signaling pathway is involved in the pathophysiology of psoriasis arthritis caused in the synovial fluid of patients with psoriasis arthritis has an enrichment of IL-17A and IL-17RA . Secukinumab is a human anti-interleukin-17A monoclonal antibody that has been recognized for the treatment of psoriasis and psoriatic arthritis . Secukinumab binds and neutralizes interleukin-17A, preventing it from interacting with IL-17 receptors expressed on keratinocytes, fibroblast-like synoviocytes, endothelial cells, chondrocytes, and osteoblasts . Meanwhile, secukinumab has been shown to block downstream inflammatory pathways that are associated with autoimmune disease. Hemolytic anemia after secukinumab administration was reported first in SOST 2020 by Rivas em et al /em . . This is a rare case, but American International Health Alliance (AIHA) is considered to be produced by a number of processes, including antibodies that are either drug-dependent or drug-independent . There is currently no guideline for the treatment of AIHA caused by secukinumab. Here, we reported our patient with autoimmune hemolytic anemia induced secukinumab. Patient and observation Patient information: a thirty-nine years old man with an established diagnosis of severe psoriasis vulgaris and psoriatic arthritis accompanied by type 1 diabetes mellitus had finished induction of secukinumab and received the first maintenance dose with the improvement of skin lesions. RO3280 He was hospitalized for drainage of soft tissue abscess at occipital region. Clinical findings: no remarkable findings besides soft tissue abscess, psoriatic lesion has diminished. Diagnostic assessment: AIHA was confirmed by Direct Antiglobulin Test (DAT) results in +4, antinuclear antibody performed using immunofluorescence with titer 1: 100 and fine speckled RO3280 pattern. Hemolysis marker, reticulocyte, and LDH were increased and subsequently improved as the hemoglobin levels increased. Diagnosis: diagnostic of AIHA was confirmed by direct antiglobulin test (DAT) with two suspected etiomechanism in this case, which are: drug-induced (secukinumab) and infection (soft tissue abscess). Unfortunately, tissue culture of the infectious specimen was not obtained, and we are unable to perform anti-drug antibody testing and neutralization. We perform Naranjos score showing +1 (possible) results for adverse drug events, the findings include previous report for similar adverse reaction (+1), occurrence of adverse events following suspected drug (+2), present of alternative cause (-1), no worsening of symptoms after readmission (-1). Therapeutic interventions: despite clinical improvement after suspected drug rechallenge and no specific treatment regarding AIHA. The Naranjos score still shows possibility. Follow-up and outcome of interventions: hemoglobin levels increase, reticulocyte count and LDH decrease, showing improvement in AIHA as shown in Table 1. Table 1 timeline of injection and laboratory changes thead valign=”top” th rowspan=”2″ colspan=”1″ Parameters /th th colspan=”14″ rowspan=”1″ Date of Treatment (2020) /th th rowspan=”1″ colspan=”1″ 29-04 /th th rowspan=”1″ colspan=”1″ 01-05 /th th rowspan=”1″ colspan=”1″ 08-05 /th th rowspan=”1″ colspan=”1″ 15-05 /th th rowspan=”1″ colspan=”1″ 22-05 /th th rowspan=”1″ colspan=”1″ 29-05 /th th rowspan=”1″ colspan=”1″ 26-06 /th th rowspan=”1″ colspan=”1″ 27-06 /th th rowspan=”1″ colspan=”1″ 24-07 /th th rowspan=”1″ colspan=”1″ 01-08 /th th rowspan=”1″ colspan=”1″ 04-08 /th th rowspan=”1″ colspan=”1″ 07-08 /th th rowspan=”1″ colspan=”1″ 10-08 /th th rowspan=”1″ colspan=”1″ 05-09 /th /thead Hemoglobin (13 – 17g/dl)13.5 Secukinumab Inititation 12.1 Secukinumab maintenance 7.99.5 Secukinumab readministered 11.511.415PCV (39 – 50%)40.6184.108.40.206635.146.6Reticulocyte—9.586.445.581.16LDH ( 250 U/L)—-436420-DAT—+4—ANA—-1:100 fine granular–C3 (90 – 180 mg/dl)—-50.3–C4 (10 – 40 mg/dl)—-9.41– Open in a separate window Patient perspective: patient expecting the continuation of the suspected drug, regarding previous clinical improvement after treatment induction. Consent was obtained, and a monitoring strategy was agreed by patient and treating physician. Informed consent: he had RO3280 given the authors permission to publish this case report. Discussion Autoimmune hemolytic anemia is common conditions found in clinical practice, despite the elaboration and diagnosis of the etiology remain a challenge for clinicians. Since, treatment will be more efficacious when the underlying etiology has been identified. Classically, AIHA has been classified into: (a) warm type AIHA; (b) cold type AIHA; and (c) mixed type AIHA, by using this classification, the identification of etiology could be assisted. Each type of AIHA has several common etiologies (Table 2) . Hemolysis in AIHA is mediated by an autoantibody to red blood cells, which identified using Direct Antiglobulin Test (DAT) or Coombs test, which identify semi-quantitatively the agglutination formation after adding the patients blood (which contain RBC coated by autoantibodies) with Coombs reagent which contain anti-human antibody resulting of hemagglutination. Despite the conflicting role of DAT in establishing autoimmune hemolytic anemia diagnosis, this method remains widely used..