While chronic immune-mediated remodeling is well recognized in aneurysm pathogenesis, this case highlights the potential for acute immune activation, possibly involving interleukin-6 and tumor necrosis factor-α (TNF-α), as well as a mildly elevated ESR, to drive abrupt vascular degradation.10) The patient had a history of treatment with infliximab and later ustekinumab for psoriasis vulgaris. This evidence concerns the gene TNF and psoriasis vulgaris.