Acute Generalised Pustular Psoriasis of Von Zumbusch: A Conflict in the Flare of Psoriatic Arthritis

Sabrina Ab Wahab​, Tarita Taib​​, N. A. Ahmad​, M. Kuppusamy​, W. S. A. Wan Ahmad Kamal​, L. D. Aminuddin​, R. Ridzwan​

2018

Abstract

Psoriasis is a chronic autoimmune disease with characteristic inflammation of the skin and joints. Immunosuppressant drugs, especially methotrexate has emerged since the past decade in psoriasis treatment, mainly for psoriatic arthritis. Withdrawal of immunosuppressant drugs may trigger a more severe condition; acute generalized pustular psoriasis, which is a rare form of psoriasis. We report a 46 years old Indian woman, who had chronic plaque psoriasis with psoriatic arthropathy for the past 3 years and was stable on oral methotrexate 10mg weekly and oral prednisolone 5mg daily. She presented with generalized pustular eruptions for 1 week associated with fever for 3 weeks and bilateral knee pain. There was widespread erythema and scaling, painful and studded with pustules appearing on all limbs, trunk and face with body surface area of more than 90% involved. She had swelling of both knees which was warm and tender. Further history revealed that she had stopped taking methotrexate for 2 weeks prior. Her condition was complicated with Klebsiella pneumoniae bacteremia and flare of psoriatic arthropathy. She was started on oral prednisolone 30mg daily, followed by tapering doses. She was monitored in the ward in view of high risk of worsening pustular psoriasis while tapering the dose of systemic corticosteroids. Her condition improved with a short course of oral acitretin 25mg daily. We discussed this case to highlight the dilemma faced by both dermatologist and rheumatologist when immunosuppressants are withdrawn in psoriatic patients and the difficulties of managing flares of psoriatic arthropathy in the same settings.

Paper Citation

in Harvard Style

Wahab​ S., Taib​​ T., Ahmad​ N., Kuppusamy​ M., Kamal​ W., Aminuddin​ L. and Ridzwan​ R. (2018). Acute Generalised Pustular Psoriasis of Von Zumbusch: A Conflict in the Flare of Psoriatic Arthritis.In Proceedings of the 23rd Regional Conference of Dermatology - Volume 1: RCD, ISBN 978-989-758-494-7, pages 477-480. DOI: 10.5220/0008160104770480

in Bibtex Style

@conference{rcd18,
author={Sabrina Ab Wahab​ and Tarita Taib​​ and N. A. Ahmad​ and M. Kuppusamy​ and W. S. A. Wan Ahmad Kamal​ and L. D. Aminuddin​ and R. Ridzwan​},
title={Acute Generalised Pustular Psoriasis of Von Zumbusch: A Conflict in the Flare of Psoriatic Arthritis},
booktitle={Proceedings of the 23rd Regional Conference of Dermatology - Volume 1: RCD,},
year={2018},
pages={477-480},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0008160104770480},
isbn={978-989-758-494-7},
}

in EndNote Style

TY - CONF

JO - Proceedings of the 23rd Regional Conference of Dermatology - Volume 1: RCD,
TI - Acute Generalised Pustular Psoriasis of Von Zumbusch: A Conflict in the Flare of Psoriatic Arthritis
SN - 978-989-758-494-7
AU - Wahab​ S.
AU - Taib​​ T.
AU - Ahmad​ N.
AU - Kuppusamy​ M.
AU - Kamal​ W.
AU - Aminuddin​ L.
AU - Ridzwan​ R.
PY - 2018
SP - 477
EP - 480
DO - 10.5220/0008160104770480