High frequency of cholestasis in generalized pustular psoriasis: Evidence for neutrophilic involvement of the biliary tract

Abstract

Generalized pustular psoriasis is a rare form of psoriasis that is sometimes associated with extracutaneous manifestations. Evidence for biliary involvement has been suggested in isolated cases. We investigated the prevalence and nature of liver abnormalities occurring in this disease. Twenty-two patients consecutively admitted for generalized pustular psoriasis who underwent liver biological tests at the time of the attack and during the following weeks were included. Twenty patients (90%) had at least one abnormal biological liver parameter. Eleven patients (50%) had pronounced abnormalities: jaundice (4/22), gammaglutamyl transferase higher than 5 times the normal value (10/22), alkaline phosphatase higher than twice the normal value (7/22), and/or aminotransferases higher than 3 times the normal value (7/22). These abnormalities returned to normal range at the time of remission of pustular psoriasis, suggesting that severe liver abnormalities could be associated with severe cutaneous disease. Neutrophilic cholangitis was observed on liver biopsy. Persistent magnetic resonance cholangiopancreatography features similar to those observed in sclerosing cholangitis were found in 3 of the 4 patients studied. No causal factor other than pustular psoriasis could be identified. In conclusion, our results demonstrate the high frequency of liver abnormalities in patients with generalized pustular psoriasis. Biliary involvement related to neutrophilic cholangitis should be added to the spectrum of extracutaneous manifestations of this disease, and physicians should be aware of such a complication. (HEPATOLOGY 2004;40:452-458.)

Cholangiosepsis Caused by Neutrophilic Cholangitis in Plaque Psoriasis

“…As described in the literature, we also found a coherence of activity of psoriasis flare and neutrophilic cholangitis [4] [5]. To date no case of neutrophilic cholangitis as an elicitor of cholangiosepsis has been reported.…”

“…The outlined findings in MRCP were similar to the key MRCP features described in patients with generalized pustular psoriasis and neutrophilic cholangitis as well as in patients with neutrophilic cholangitis and psoriasis vulgaris or psoriatic arthritis [1] [4] [5].…”

Psoriasis vulgaris and digestive system disorders: is there a linkage?

“…The jaundice episodes were of unclear pathogenesis, but some neutrophilic cholangitis was documented on liver biopsy. It raised the question whether the organ was the subject to the same disorder as the skin, inasmuch accumulation of neutrophils in the epidermis is one of the vital histological features of pustular psoriasis [12,13]. Apart from biliary involvement in the course of pustular psoriasis, nonalcoholic steatohepatitis was linked to psoriasis vulgaris [10,11].…”

“…A few authors have related psoriasis and disturbances of the incretory and excretory pancreatic functions and even acute pancreatitis [7][8][9]. Single reports on liver dysfunction or chronic liver disease in psoriatic individuals have been published, including hepatic cirrhosis or psoriasis being a cutaneous sign of hepatocellular carcinoma [10][11][12][13][14].…”

Traitement du psoriasis en pratique pour le rhumatologue

“…Le psoriasis pustuleux généralisé constitue une forme grave de psoriasis qui a été associé à la survenue d'une atteinte biliaire à type de cholangite sclérosante [2]. Le psoriasis est une maladie affichante, invalidante qui peut avoir un impact sur la qualité de vie des patients, équivalent à celui de maladies perç ues comme plus graves comme le diabète, l'insuffisance coronarienne ou l'asthme [3].…”