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CASE 2 Presentation: 60-Year-Old Woman With A Long History of GPP


Boni Elewski, MD, reviews a case of a woman in the emergency department with a severe GPP flare.

Raj Chovatiya, MD, PhD: Well, I am biased, but I think that was sort of an interesting case and your perspective, was really, really valued, Boni. Let's transition over to your interesting case and see what pearls we can unearth from that. You want to maybe give us a little summary of your patient and sort of what the course was like?

Boni Elewski, MD: So, my lady is a 60-ish-year-old woman who had psoriasis when she was about 15. And she was on a variety of biologics before I met her. Most recently, she had been on guselkumab for 2 years and it was working fine. She had decided to start an antibiotic for some problem and may have gotten a rash from it. I wasn't clear on that because she was coming from out of state, went to see a doctor because of her itch, and they gave her a shot of steroids. And then they gave her some sort of dose pack. And within a couple days, she was life-flighted in the middle of the night to our emergency room. So, she came in, bright red, edematous, toxic, pustules head to toe, utterly miserable, afraid she was going to die, and she very well could have died. She was a mess. She was covered head to toe. When I saw her, the diagnosis was quite apparent, though we did think, well, could this be AGEP [acute generalised exanthematous pustulosis]? Because she had been on an antibiotic prior to all this, but it was definitely not AGEP based on the clinical appearance. Again, she was toxic, she was red, she was edematous, and the pustules were big, not the monomorphic tinier pustules you get with AGEP. And the initial reaction in the ICU (intensive care unit) was to start her on vancomycin and that obviously wasn't working. We came and saw her and got her the correct diagnosis and was able to get spesolimab. So, before we got it, there was a little lag before we could get it, 24, 36 hours, I think. It might have been 36 hours, a little more, because I saw her on a Sunday, and I couldn't get it until Tuesday morning, and during that time, she was on topical steroids with wet compresses and just regular care to keep her vital signs functioning fine, and fluid, and so forth. But she got her first infusion, first and only infusion, the 900 milligrams of spesolimab, and within 24 hours she was clear. She was clear, no pustules, and she was still slightly pink, but she had no pustules. Her edema went down. It was truly remarkable when you see the photo. And she felt better.

Transcript edited for clarity.

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