Successful treatment of generalized pustular psoriasis with biological agents: a case report and bibliographic review

Abstract

Generalized pustular psoriasis (GPP) is a multisystem, acute and severe variant of psoriasis with a clinical presentation of erythematous and edematous plaques on which multiple pustules appear. Systemic manifestations are frequent and often severe. Complications that can develop include sepsis and kidney, liver, respiratory, and heart failure. 50% of patients require hospitalization. Reported mortality rates are 2 to 16%.

We present the case of a 21-year-old female patient with history of plaque psoriasis, located in the lower extremities, with 3 years of evolution and with poor adherence to treatment based on topical steroids. The patient began suffering from the condition 48 hours prior to her admission to the emergency department with pustular, painful, erythematous-based lesions that covered 100% of the total body surface, in addition to multiple systemic conditions such as shock, tachycardia, tachypnea, hypotension and fever. The diagnosis of GPP was confirmed by the skin biopsy that reported morphological changes consistent with psoriasiform dermatitis. Treatment with vasopressors and biological agents was initiated, achieving remission of the clinical case.