SHM Converge Scientific Abstract ePoster Gallery-Rash Decisions: Atypical Psoriasform Drug Rash

Pdf Summary

This case describes a 62-year-old hospitalized woman with COVID-19 pneumonia who developed an acute, pruritic, erythematous papular rash with a scaly, psoriasiform appearance on hospital day 11. The eruption was distributed on the bilateral flanks, lower extremities, and plantar feet, without mucosal involvement or other systemic abnormalities. Laboratory studies were normal, including CBC and CMP, and there was no eosinophilia.<br /><br />During hospitalization, she had received remdesivir, dexamethasone, baricitinib, ceftriaxone, doxycycline, lisinopril, and metoprolol. Because of the timing and morphology, a drug-induced eruption was suspected. Punch biopsy of the left flank showed psoriasiform epidermal hyperplasia with parakeratosis and intracorneal microabscesses, supporting a psoriasiform drug rash.<br /><br />The main possible culprits were baricitinib, doxycycline, and metoprolol. Doxycycline had already been completed, baricitinib was stopped, and metoprolol was continued because its benefits were judged to outweigh the risk. She was treated with triamcinolone cream and had complete resolution of the rash by one-month follow-up.<br /><br />The discussion emphasizes that while maculopapular drug eruptions are the most common inpatient drug rashes, clinicians should also recognize less common but important patterns such as psoriasiform eruptions. These have been associated with beta-blockers, lithium, antimalarials, NSAIDs, and tetracyclines. Baricitinib has also been linked to palmoplantar pustulosis-like eruptions. Steroid withdrawal and infection-related triggers were also considered, though COVID-19 more commonly causes a viral exanthem rather than a psoriasiform rash.

Asset Subtitle

Nicholas Piazza

Meta Tag

Author List David Hemsey, Nicholas Piazza

Category Clinical Vignettes

Concept Psoriasiform Drug Rash

Concept Drug Eruption

Concept Psoriasiform Epidermal Hyperplasia

Concept Beta Blockers

Concept Tetracyclines

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Nicholas Piazza

Track Adult

Keywords

COVID-19 pneumonia

psoriasiform drug rash

drug-induced eruption

baricitinib

doxycycline

metoprolol

pruritic papular rash

punch biopsy

intracorneal microabscesses

palmoplantar eruption

Psoriasiform Drug Rash

Drug Eruption

Psoriasiform Epidermal Hyperplasia

Beta Blockers

Tetracyclines