A 27-year-old gentleman was admitted for fever and generalised pustular eruption for 2 days
Dr. Adrian KC Cheng
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Clinical history:
A 27-year-old gentleman was admitted for fever and generalised pustular eruption for 2 days. He had a history of psoriasis with psoriatic arthropathy involving both axial and peripheral joints since childhood. His previous treatment include acitretin and methotrexate. Adalimumab subcutaneous injection was started three years ago for worsening of spondylarthritis as evidenced in his magnetic resonance imaging. He denied any use of systemic corticosteroid or other medications. He had a fever up to 39°C. Dermatological examination revealed polycyclic and annular erythematous plaques with coalescing pustules at the advancing edge over his chest, abdomen, arms and legs. There was central clearing in some of the lesions with crusts and trailing scales. Blood tests on admission showed mild neutrophilia. Serum bilirubin and transaminases were elevated to around two times the upper limit of normal. Ultrasonography showed no evidence of biliary obstruction.
What is the diagnosis?
| A. | Acute generalised pustular dermatosis |
| B. | Miliaria rubra |
| C. | Superficial bacterial folliculitis |
| D. | Generalised pustular psoriasis |