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Acute Generalized Exanthematous Pustulosis Difficult to Distinguish from Pustular Psoriasis after the Use of Contrast Medium in a Patient with Psoriasis Vulgaris
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- Sakai Naohiro
- Showa University Northern Yokohama Hospital
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- Watanabe Hideaki
- Showa University Northern Yokohama Hospital
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- Kobayashi Kae
- Department of Dermatology, Showa University School of Medicine
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- Sasaki Syun
- Department of Dermatology, Showa University School of Medicine
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- Hirai Yuka
- Department of Dermatology, Showa University School of Medicine
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- Murakami Haruko
- Department of Dermatology, Showa University School of Medicine
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- Sueki Hirohiko
- Department of Dermatology, Showa University School of Medicine
Bibliographic Information
- Other Title
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- 尋常性乾癬患者に造影剤を使用後,全身に膿疱が多発し膿疱性乾癬との鑑別に苦慮した急性汎発性発疹性膿庖症の 1 例
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Description
<p>A 37-year-old man was admitted with fever in the 38°C range, erythema with skin flushing and scaling all over the body, and numerous needle-head-sized pustules, some of which had fused to form a sea of pus. He had a paternal history of psoriasis vulgaris and had himself suffered from the condition for 10 years. He had earlier complained of chest pain, and his creatine kinase level was high ; thus, he underwent contrast (iohexol) -enhanced computed tomography 6 days before admission. On admission, his Psoriasis Area Severity Index (PASI) score was 54.1, neutrophil count was 21,000/μL, and C-reactive protein level was 29.79 mg/dL. Bacterial culture of the pustules was negative. Histopathological examination revealed a thickened club-shaped epidermis,hyperkeratosis, and loss of the granular layer. Some neutrophil aggregations were observed under the stratum corneum, and there were many spongiform pustules. We diagnosed pustular psoriasis preceded by psoriasis vulgaris. We administered topical systemic steroids and oral etretinate capsules (30 mg/day). The rash rapidly improved, and 13 days after admission, the patient was discharged with a PASI score of 22.4. The rapid improvement of the rash suggested that iohexol may have triggered acute generalized exanthematous pustulosis (AGEP) ; thus, additional tests were performed. Iohexol drug-induced lymphocyte stimulation test was negative, the patch test was positive, and we detected no mutation in the IL36RN gene or CARD14 gene exon 2-4. The AGEP score was 10 (using the criteria of the Euro SCAR study group). He met the diagnostic criteria for both pustular psoriasis and AGEP. We diagnosed AGEP based on the rapid disease improvement and the positive patch test. We report a case for whom it was difficult to distinguish AGEP from pustular psoriasis because of the many similarities between the two conditions. Skin Research,21: 288-294,2022 </p>
Journal
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- Hifu no kagaku
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Hifu no kagaku 21 (4), 288-294, 2022
Meeting of Osaka Dermatological Association/Meeting of Keiji Dermatological Association
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Keywords
Details 詳細情報について
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- CRID
- 1390295658313895552
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- ISSN
- 18839614
- 13471813
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- Text Lang
- ja
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- Data Source
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- JaLC
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- Abstract License Flag
- Disallowed