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Autumn 2016, Vol. 24 No. 3

Hong Kong J. Dermatol. Venereol. (2016) 24, 141-144


Case Report

A case of generalised pustular psoriasis mimicking acute generalised exanthematous pustulosis

一宗原以為急性泛發性發疹性膿皰症的泛發性膿皰型銀屑病案例

CS Park 朴贊仙 and SY Jung 鄭素榮

Abstract

Differentiating between acute generalised exanthematous pustulosis (AGEP) and generalised pustular psoriasis (GPP) is very challenging because of clinical and histopathological similarities. A 60-year-old woman presented with pustular eruption and fever. She had taken dapsone and zaltoprofen for five days. Laboratory findings revealed neutrophil dominant leucocytosis and histopathological findings revealed a subcorneal spongiform pustule. Under the diagnosis of AGEP, she was treated with systemic steroids. However, the pustular lesions were aggravated after steroid reduction. In light of GPP, she was treated with acitretin and showed a good response. This case highlights the difficulty of differentiation between GPP and AGEP.

因臨床和組織病理學上的相似,要區別急性泛發性發疹性膿皰症和泛發性膿皰型銀屑病存在一定挑戰。一名60歲女仕身上呈現膿皰性皮疹,伴隨發燒徵狀;而過去五天患者曾服用氨苯碸和扎托洛芬。化驗結果顯示出以嗜中性白血球為主的白細胞增多,組織病理學可見角質層下海綿狀膿皰,病情與急性泛發性發疹性膿皰症吻合,故獲處方全身性類固醇治療。然而,膿皰在減少類固醇劑量後反覆惡化,固診斷重新修訂為泛發性膿皰型銀屑病,改用阿維A治療,並得到良好的療效。這宗病例突顯出泛發性膿皰型銀屑病和急性泛發性發疹性膿皰症兩者之間的辨別困難。

Keywords: Acute generalised exanthematous pustulosis, dapsone, generalised pustular psoriasis, pustular eruption, subcorneal pustule

關鍵詞: 急性泛發性發疹性膿皰症、達普頌(氨苯碸)、泛發性膿皰型銀屑病、膿皰性皮疹、角質層下膿皰