ISSN: 2574-7800
Authors: Namisato M* and Ogawa H
A case of pustulosis palmaris et plantaris or palmoplantar pustulosis (PPP) accompanied by generalized skin eruption is presented. Extra-palmoplantar skin lesions similar to those in psoriasis were observed. After the initiation of apremilast administration and phototherapy, most skin lesions were well controlled. After 1 month, chest pain of the sternocostal joint area occurred. Magnetic resonance imaging revealed bone marrow edema in the sternum body and manubrium. This finding was considered pustulotic arthro-osteitis, observed in a patient with PPP. After the administration of secukinumab, the patient’s chest pain diminished. However, after 20 weeks, palmoplantar skin eruption flared up, making walking difficult. Then, secukinumab was switched to guselkumab. The therapy worked gradually; however, after 16 weeks, a sudden aggravation occurred. The patient experienced severe chest pain and nail deformities. Approximately 1 month later, these symptoms improved under the continuous administration of guselkumab. This abrupt exacerbation was considered a paradoxical reaction, affected by guselkumab. After the aggravation subsided, the patient has been kept in a satisfactory condition.
Keywords: Palmoplantar pustulosis; Pustulotic arthro-osteitis; Guselkumab; Paradoxical reaction
