Bilateral periocular psoriasis: an initial manifestation of acute generalized pustular psoriasis with coexistent Sjögren's syndrome.
A 21-year-old febrile lady presented to the emergency service with severe lid oedema, conjunctivitis, dry mouth and abdominal skin rash. Over 5 days, she developed silvery scales and pustules on the lids, and generalized pustules on an erythematous base. Multiple focal sterile corneal infiltrates were seen. Haematological investigations and a skin biopsy were done as the consulting dermatologist suspected acute generalized pustular psoriasis. In addition, secondary Sjögren's syndrome was diagnosed since she had keratoconjunctivitis sicca, xerostomia, raised erythrocyte sedimentation rate and positive antinuclear antibodies. The presence of microabscesses in the epidermis on skin biopsy confirmed the diagnosis of pustular psoriasis. With oral methotrexate 7.5 mg weekly and topical corticosteroids, the acute condition gradually resolved; however, the keratoconjunctivitis sicca is persisting. Secondary Sjögren's syndrome associated with acute generalized pustular psoriasis and ocular psoriasis is extremely rare. Awareness of the ocular and dermatological features of these two conditions would result in earlier diagnosis and institution of appropriate treatment.
Fernandes
Merle
M
Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, India. merle@vizag.lvpei.org
Vemuganti
Geeta K
GK
Rao
Gullapalli N
GN
D000208:Acute Disease; D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D001623:Betamethasone; D004359:Drug Therapy, Combination; D005141:Eyelid Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008727:Methotrexate; D009916:Orbital Diseases / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011239:Prednisolone; D011565:Psoriasis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012859:Sjogren's Syndrome / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001623:Betamethasone; D011239:Prednisolone; D008727:Methotrexate