Steroid-resistant Acute Generalized Exanthematous Pustulosis Mimicking Generalized Pustular Psoriasis Successfully Treated by Methotrexate

Acute generalized exanthematous pustulosis is a rare drug-induced eruption that is characterized by sterile non-follicular pustules arising on an often edematous diffuse erythematous background. Generalized pustular psoriasis is an acute and severe clinical form of psoriasis presenting as pustular eruption with erythematous base. Differentiating both diseases is often challenging because of their clinical and histopathological similarities. A 62-year-old woman presented with pustular eruption and fever three days after taking propyphenazone. Laboratory findings revealed leukocytosis and neutrophilia. Histopathological findings revealed a subcorneal spongiform pustule filled with neutrophils and perivascular inflammatory cell infiltration with neutrophils in the dermis. She was initially treated with systemic steroids, however, the lesions showed insignificant improvement. Treatment was then shifted to methotrexate which resulted in a dramatic clinical improvement.

Unusual Presentation of Pustular Eruption in Kawasaki Disease Shock Syndrome: A Case Report

The present study case report described a 46-month-old girl with Kawasaki disease shock syndrome (KDSS) who presented with five days of fevers, unilateral cervical lymphadenitis, pustular eruption, maculopapular rashes, erythema of palms and soles, conjunctivitis, cracked lips, and shock. Laboratory results showed elevated ESR & CRP, leukocytosis, normocytic anemia, and transaminitis. Pustular eruption Gram and Wright stains demonstrated numerous neutrophils. Echocardiogram showed normal results. Fluid resuscitation, broad spectrum antibiotics, inotropic drug, IVIG, and high dose aspirin were given. Diagnosis of Kawasaki disease was supported by clinical and laboratory features at the acute phase, in conjunction with periungual peeling of fingers and toes and thrombocytosis at the subacute phase. The patient made a complete recovery.The present study case showed an unusual pustular eruption in KDSS. Clinicians should consider these presentations to the diagnosis of KDSS and timely prescribed IVIG, to prevent coronary artery aneurysm. Keywords: Pustular eruption; Kawasaki disease shock syndrome