A dramatic response to a single dose of infliximab as rescue therapy in acute generalized pustular psoriasis of von Zumbusch associated with a neutrophilic cholangitis.
Generalized pustular psoriasis of von Zumbusch is an unstable, inflammatory form of psoriasis, with the hallmark of neutrophil infiltration in cutaneous as well as extracutaneous lesions. It is often recalcitrant, making treatment difficult. Tumour necrosis factor-alpha antagonists including infliximab have been used with success in treating recalcitrant cases. We report a case of a 48-year-old Chinese female patient with a long-standing history of poorly controlled generalized pustular psoriasis which was resistant to multiple therapies. During a severe flare, a single dose of infliximab resulted in rapid clearing of cutaneous lesions, together with resolution of liver function abnormalities that are likely secondary to neutrophilic cholangitis. Subsequent maintenance therapy with acitretin allowed remission of pustular disease for 7 months. This demonstrates the efficacy of single-dose infliximab for both cutaneous lesions and systemic hepatic involvement in generalized pustular psoriasis.
Chandran
Nisha Suyien
NS
Dermatology, National Skin Centre, 1 Mandalay Road, Singapore 308205. nishasuch@gmail.com
Chong
Wei-Sheng
WS
D017255:Acitretin / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D044466:Asian People; D002761:Cholangitis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008111:Liver Function Tests; D008875:Middle Aged; D020556:Neutrophil Infiltration; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D017255:Acitretin