case_images: PMC3481919_01
case_images: Generalized pustular eruption coalescing into lakes at several places
case_images: IDOJ-3-42-g001.jpg
case_images: PMC3481919_01_IDOJ-3-42-g001.jpg
case_images: F1
case_images: He had nonfollicular pustules over his entire body that coalesced into lakes at several places [Figure 1]. Plaque lesions of psoriasis were evident over the elbow prominences and abdomen [Figure 1].
case_images: Conjunctival and genital mucosal involvement
case_images: IDOJ-3-42-g002.jpg
case_images: PMC3481919_01_IDOJ-3-42-g002.jpg
case_images: F2
case_images: Erosions were noted over the palpebral conjunctiva and glans penis [Figure 2].
case_images: Orthokeratosis, acanthosis with spongiosis and a superificial dermal lymphocytic infiltrate (H and E, x40)
case_images: IDOJ-3-42-g003.jpg
case_images: PMC3481919_01_IDOJ-3-42-g003.jpg
case_images: F3
case_images: Skin biopsy revealed orthokeratosis, mild acanthosis with spongiosis and a superificial dermal lymphocytic infiltrate [Figure 3].
case_images: Reappearance of pustules encircling erstwhile plaques of psoriasis
case_images: IDOJ-3-42-g004.jpg
case_images: PMC3481919_01_IDOJ-3-42-g004.jpg
case_images: F4
case_images: However, pustules reappeared on the seventh day, encircling the erstwhile plaque lesions of psoriasis [Figure 4].
case_images: Second biopsy showing parakeratosis, acanthosis, spongiform neutrophilic abscesses, papillomatosis and a patchy lympho-mononuclear infiltrate in the superficial dermis (H and E, x10, x100)
case_images: IDOJ-3-42-g005.jpg
case_images: PMC3481919_01_IDOJ-3-42-g005.jpg
case_images: F5
case_images: A second skin biopsy revealed parakeratosis, acanthosis, spongiform neutrophilic abscesses, papillomatosis and a patchy lympho-mononuclear infiltrate in the superficial dermis, confirming pustular psoriasis [Figure 5].
case_images: Clearance of pustular lesions after adding etanercept to ongoing methotrexate, acitretin and NBUVB
case_images: IDOJ-3-42-g006.jpg
case_images: PMC3481919_01_IDOJ-3-42-g006.jpg
case_images: F6
case_images: The patient turned afebrile after two doses of etanercept, with complete clearance of the pustular eruption after 1 week [Figure 6].