UMEM Educational Pearls

Title: What's the Diagnosis? Case written by Dr. Zachary Dezman

Posted: 3/18/2013 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Question

A 56-year-old woman with a history of psoriasis presents with fever, nausea, and painful pin-point pustules on an erythematous base. Her dermatologist recently reduced her prednisone dose. What's the diagnosis?

Answer

Answer: Pustular psoriasis

Pustular psoriasis

Occurs in patients with psoriasis, classically occurring after a decrease in dose or cessation of systemic steroids

Symptoms include:

Acute eruption of painful small pustules (2-3 mm in diameter) that rapidly become confluent into large “lakes of pus”
Systemic symptoms may also occur (e.g., fever, malaise, nausea, or arthritis).

These lesions can eventually drain and desquamate, leaving large patches of exposed dermis.

Complications include:

Super-infection (most common)
ARDS
AKI
Hypothermia secondary to loss of epidermis
Hypovolemia secondary to fluid losses from the skin

Patients may be admitted for supportive care and treatment with disease-modifying antirheumatic drugs (DMARDs) such as cyclophosphamide or methotrexate.

REFERENCE

L Naldi, D Gambini, The clinical spectrum of psoriasis, Clinics in Dermatology, Volume 25, Issue 6, November–December 2007, Pages 510-518

References

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)