Generalised pustular psoriasis complicated by acute respiratory failure
Abstract
We present a case of a female admitted to the Department of Dermatology, due to a generalised pustular eruption. The first symptoms appeared after a respiratory tract infection 4 months before the hospitalisation and were treated with systemic cyclosporine. Two weeks before hospital admission the treatment was discontinued. On admission, the patient was in a good general condition with laboratory tests revealing increased CRP (C Reactive Protein) and significant anaemia. The patient underwent multiple blood transfusions, subsequently, the course of the disease was complicated by respiratory failure requiring intubation and transfer to the intensive care unit. Increased serum inflammatory markers and procalcitonin levels along with negative blood and skin cultures were observed during the hospital stay. Based on the clinical picture, laboratory tests and the course of the disease a diagnosis of generalised pustular psoriasis was made. The patient was treated with symptomatic treatment, intravenous immunoglobulin infusions and oral acitretin with gradual resolution of the skin lesions.
Keywords: generalised pustular psoriasisacute respiratory failureacute generalised exanthematous pustulosis
References
- Boehner A, Navarini AA, Eyerich K. Generalized pustular psoriasis - a model disease for specific targeted immunotherapy, systematic review. Exp Dermatol. 2018; 27(10): 1067–1077.
- Hoegler KM, John AM, Handler MZ, et al. Generalized pustular psoriasis: a review and update on treatment. J Eur Acad Dermatol Venereol. 2018; 32(10): 1645–1651.
- Neuhauser R, Eyerich K, Boehner A. Generalized pustular psoriasis-Dawn of a new era in targeted immunotherapy. Exp Dermatol. 2020 [Epub ahead of print].
- Bachelez H. Pustular psoriasis and related pustular skin diseases. Br J Dermatol. 2018; 178(3): 614–618.
- Takeichi T, Akiyama M. Generalized Pustular Psoriasis: Clinical Management and Update on Autoinflammatory Aspects. Am J Clin Dermatol. 2020; 21(2): 227–236.
- Navarini AA, Burden AD, Capon F, et al. ERASPEN Network. European consensus statement on phenotypes of pustular psoriasis. J Eur Acad Dermatol Venereol. 2017; 31(11): 1792–1799.
- Fujita H, Terui T, Hayama K, et al. Japanese Dermatological Association Guidelines Development Committee for the Guidelines for the Management and Treatment of Generalized Pustular Psoriasis. Japanese guidelines for the management and treatment of generalized pustular psoriasis: The new pathogenesis and treatment of GPP. J Dermatol. 2018; 45(11): 1235–1270.
- Choon SE, Lai NM, Mohammad NA, et al. Clinical profile, morbidity, and outcome of adult-onset generalized pustular psoriasis: analysis of 102 cases seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol. 2014; 53(6): 676–684.
- Kluger N, Bessis D, Guillot B, et al. Acute respiratory distress syndrome complicating generalized pustular psoriasis (psoriasis-associated aseptic pneumonitis). J Am Acad Dermatol. 2011; 64(6): 1154–1158.
- Landry M. Generalized Pustular Psoriasis. Arch Dermatol. 1972; 105(5): 711.
- Abou-Samra T, Constantin JM, Amarger S, et al. Generalized pustular psoriasis complicated by acute respiratory distress syndrome. Br J Dermatol. 2004; 150(2): 353–356.
- Wang S, Xie Z, Shen Z. Serum procalcitonin and C-reactive protein in the evaluation of bacterial infection in generalized pustular psoriasis. An Bras Dermatol. 2019; 94(5): 542–548.
- Feldmeyer L, Heidemeyer K, Yawalkar N. Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy. Int J Mol Sci. 2016; 17(8).
- Szatkowski J, Schwartz RA. Acute generalized exanthematous pustulosis (AGEP): A review and update. J Am Acad Dermatol. 2015; 73(5): 843–848.
- Sidoroff A, Dunant A, Viboud C, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR). Br J Dermatol. 2007; 157(5): 989–996.
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