A 52-year-old woman, without a history of psoriasis, developed a widespread, sterile pustular eruption on the trunk and extremities 2 days after subcutaneous injection of dexamethasone solution. Skin biopsy revealed subcorneal pustules filled with neutrophils and moderate lymphohistiocytic infiltrate with a few eosinophils in the dermis. There was no evidence of vasculitis. Patch testing showed positive pustular reactions to dexamethasone solution. Histology of this pustule also resembled that of the original eruption. To our knowledge, acute generalized exanthematous pustulosis due to corticosteroid has not been previously reported.
We report the case of a 51-year-old Japanese man with a unique pustulosis. He had multiple erythematous plaques and numerous pinpoint pustules on the trunk and extremities resembling pustular psoriasis. Histologic features revealed a fully developed intraepidermal abscess filled with neutrophils and disrupted epidermal keratinocytes. Mild leukocytosclastic vasculitis was seen in the underlying dermis. A direct immunofluorescence study revealed IgM, C1q, C3 and fibrinogen deposits in the dermal vessels. The patient had also sternoclavicular hyperostosis. We think that this represents a unique type of pustular vasculitis distinct from pustular psoriasis.
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