Abstract:

A 38-year-old female with a past medical history of psoriasis, well-controlled on Geselkumab, presented to the emergency department due to sudden onset of a full-body, blistering, desquamative rash. Seven days prior to her presentation, she had undergone surgery with peri-operative Keflex, despite history of a desquamating skin reaction to penicillin (PCN) at age 17. Her rash began five days after and progressively worsened until her arrival. Given her presentation and history of desquamative drug reactions, there was high concern for Stevens-Johnson syndrome (SJS) and/or toxic epidermal necrolysis (TEN) and she was admitted to the burn unit. After dermatology consult, it was noted that the desquamated areas had more shallow intraepidermal splits than are typically seen in SJS/TEN. Rush biopsy was significant for subcorneal pustules with separation of the stratum corneum, necrotic keratinocytes, a sparse dermal inflammatory infiltrate, and occasional eosinophils. The biopsy lacked the tortuous papillary dermal capillaries and increased basal mitoses seen in conventional psoriasis and lacked the full thickness epidermal necrosis and subepidermal bullae seen in SJS/TEN. The clinical and histopathologic features were most consistent with a drug-aggravated or induced pustular psoriasis. This case illustrates the importance of attention to the patient’s underlying conditions and medical history when evaluating desquamating processes and brings attention to less-common drug-related eruptions such as drug-induced or aggravated psoriasis.

Financial Disclosure:
No current or relevant financial relationships exist.

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Andrew Berman, MD