SHM Converge Scientific Abstract ePoster Gallery-A Challenging Case of Widespread Cutaneous Rash and Desquamation

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A 64-year-old woman presented with a progressively worsening, widespread, intensely pruritic and painful rash after receiving systemic corticosteroids for a presumed psoriasis flare. She had experienced similar, milder eruptions in prior years that improved with oral steroids, but this episode became far more extensive. On examination, she had diffuse erythema with hyperpigmented patches, hypopigmented centers, pustules, plaques, and later rapidly developing flaccid blisters followed by near-total desquamation. The eruption spared the palms, soles, and genitalia.<br /><br />Because of concern for superinfection, she was started on antibiotics and later transferred to the ICU after developing shock and severe fluid loss from skin barrier failure. Vancomycin and aggressive IV fluid resuscitation were added, and hydrocortisone was given because of possible adrenal suppression from prior steroid use. Skin biopsy ultimately confirmed erythrodermic psoriasis. She improved after treatment with cyclosporine and intensive wound care using triamcinolone ointment with wet wraps and occlusion.<br /><br />The case highlights that systemic corticosteroids can precipitate severe psoriasis flares, including pustular and erythrodermic psoriasis. Erythrodermic psoriasis is a dermatologic emergency affecting at least 75% of the body surface area and can cause life-threatening complications such as hypovolemic shock, infection, and sepsis. Clinicians should consider this diagnosis when a worsening rash follows steroid exposure.

Asset Subtitle

Omar Fahmy

Meta Tag

Author List Aastha Gupta, Hemanth Kilaru, Omar Fahmy, Sadichchha Parajuli

Category Clinical Vignettes

Concept Erythrodermic Psoriasis

Concept Systemic Corticosteroid

Concept Hypovolemic Shock

Concept Sepsis

Concept Cyclosporine

Distinguished Non-Finalist

Presenter Organization Sound Physicians - MultiCare Good Samaritan Hospital

Presenting Author Omar Fahmy

Track Adult

Keywords

erythrodermic psoriasis

systemic corticosteroids

pustular psoriasis

pruritic rash

skin biopsy

hypovolemic shock

sepsis

cytosporine

wet wraps

dermatologic emergency

Erythrodermic Psoriasis

Systemic Corticosteroid

Hypovolemic Shock

Sepsis

Cyclosporine