case_images: PMC10920288_01
case_images: (A) The timeline of the GPPASI score and mNAPSI score during treatment with different biologics. (B) Periungual erythema, periungual and subungual pustules and onychodystrophy on swollen distal fingers in different periods. (C) Skin lesions on the trunk and both lower limbs and variation in the WBC and CRP. GPPASI, generalized pustular psoriasis area and severity index; mNAPSI, modified nail psoriasis severity index; WBC, white blood cells; CRP, C-reactive protein.
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case_images: PMC10920288_01_fimmu-15-1338285-g001.jpg
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case_images: August 2020, the patient was hospitalized with a diagnosis of GPP, as generalized pustules reappeared accompanied by leucocytosis and elevated C-reactive protein (CRP) levels ( Figures 1A-D ). A loading dose of 80mg of adalimumab was prescribed, followed by a subsequent dose of 40mg every 4 weeks, which led to a significant improvement in skin lesions within 3 weeks. Despite occasional recurrences of the psoriasis rash due to stress or respiratory infection during 15 months of treatment, the nail lesions persisted ( Figure 1B ). Improvement was observed 2 weeks after the initial injection, and after three months of treatment, the skin lesions were nearly completely resolved ( Figure 1C ). Laboratory investigations indicated leukocytosis with neutrophilia, as well as elevated levels of CRP ( Figure 1 ).
case_images: The flowchart of the patient before and after a single dose of spesolimab treatment and GPPASI and mNAPSI scores at baseline, Day 1, Day 5, week 9 and week 32. (A-D) Clinical appearance of the trunk, right arm, hands and toes before treatment; (E-H) Clearance of existing pustules and enlarged erythema on the trunk and right arm on Day 1 after treatment; clinical appearance 5 days (I-L), 9 weeks (M-P), and 32 weeks (Q-T) After treatment with spesolimab.
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case_images: PMC10920288_01_fimmu-15-1338285-g002.jpg
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case_images: The nails on these affected digits showed signs of dystrophy and were adorned with pustules ( Figures 2A-D ). Figures 2E-H ), Day 5 ( Figures 2I-L ), week 9 ( Figures 2M-P ), and week 32 ( Figures 2Q-T ). Following the infusion of spesolimab, pustules were significantly alleviated on the trunk and upper limbs. However, within 24 hours, several new erythematous patches emerged, extending to the patient's forearms and a substantial portion of their trunk ( Figures 2E, F ). By Day 5, the erythema had darkened on the trunk while subsiding on the upper limbs, leaving behind scaling ( Figures 2I, J ), with no observed changes in the nail lesions ( Figures 2K, L ). At week 9, a remarkable improvement was witnessed, with a 63% reduction in the GPPASI score ( Figures 2M, N ). Periungual inflammation diminished, and all affected fingernails began to regenerate (Figures 2O-P). After 32 weeks of spesolimab use, the patient's skin and nail lesions had largely disappeared (Figures 2Q-T).