A Case of Acute Generalized Pustular Psoriasis of von Zumbusch Triggered by Hypocalcemia

Abstract

Psoriasis is an autoimmune disease triggered by different conditions in genetically susceptible people. It is characterized by variable cutaneous manifestations including localized or disseminated pustules. Generalized pustular psoriasis (GPP) has two main clinical forms: von Zumbusch psoriasis, characterized by severe erythrodermia and scaling skin after the resolution of pustules, and the annular form. GPP may also present severe extracutaneous manifestations including pneumonitis, heart failure and hepatitis. Old reports showed a relationship between hypoparathyroidism and hypocalcemia as triggers for GPP highlighting the importance of adequate workup of the patient and possible therapeutic changes in acute situations. Here, we present a case of severe von Zumbusch psoriasis with life-threatening complications triggered by severe hypocalcemia secondary to hypoparathyroidism successfully treated with aggressive calcium reposition.

Generalized pustular psoriasis – a model disease for specific targeted immunotherapy, systematic review

“…Several case reports also mention electrolyte disorders, more specifically hypocalcaemia eg secondary to hypoparathyroidism as a trigger for GPP. In one case, treatment with intravenous calcium and cholecalciferol even lead to a complete remission of GPP …”

“…In one case, treatment with intravenous calcium and cholecalciferol even lead to a complete remission of GPP. [5,17,53,54]…”

Chronic hypoparathyroidism in adults: clinical features, diagnosis, management and treatment

“…у 76% пациентов с хроническим гипопаратиреозом были выявлены те или иные поражения кожи и ее придатков: сухость кожи наблюдалась в 52% наблюдений, у 52-62% -потеря волос подмышечных и лобковых областей, 9,5% имели алопецию, у 38% отмечалась ломкость ногтей с последующим онихолизисом у 29% [50]. Описаны случаи тяжелого пустулезного псориаза, ассоциированного с гипокальциемией, с существенным улучшением на фоне достижения нормокальциемии [51].…”

Beinschmerz – dermatologische Ursachen

“…There is often a mixed streptococcal and staphylococcal infection. The clinical picture is to be taken seriously, as involvement of the fascia (necrotising fasciitis) may have a fulminating course [8]. Besides the necessary surgical intervention, systemic antibiotic therapy is the mainstay of treatment.…”