Recognizing Multiple Diagnoses: Von Zumbusch Generalized Pustular Psoriasis Flare and Adverse Drug Effect

Abstract

Von Zumbusch generalized pustular psoriasis (GPP) is a rare and severe type of psoriasis that presents as superficial pustules which coalesce into lakes of pus with erythema and scaling, with associated fever and life-threatening complications including sepsis. Here we describe a patient with a history of von Zumbusch GPP who presented with erythroderma, neutrophilic leukocytosis, and hyperbilirubinemia in the setting of missed medication dose and hip surgery. While her laboratory abnormalities were initially attributed to a flare of her underlying skin disease, when treatment of her psoriasis flare failed to correct the laboratory abnormalities, review of her biopsy showed evidence of a concomitant adverse drug effect and the patient ultimately expired due to sepsis.