Infliximab for the treatment of recalcitrant generalized pustular psoriasis of pregnancy: report of a challenging case

G Babuna Kobaner, A Polat Ekinci - Dermatologic Therapy, 2020 - Wiley Online Library
G Babuna Kobaner, A Polat Ekinci
Dermatologic Therapy, 2020Wiley Online Library
Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis, is a rare
gestational dermatosis that may induce life‐threatening complications for both the mother
and fetus. Treatment of recalcitrant generalized PPP may be challenging as available
therapeutic options are limited. We herein present a 24‐year‐old pregnant woman with
generalized PPP accompanied by high fever, fatigue, leukocytosis, and elevated levels of
serum acute phase reactants. The patient was resistant to a combination treatment of high …
Abstract
Pustular psoriasis of pregnancy (PPP), also known as impetigo herpetiformis, is a rare gestational dermatosis that may induce life‐threatening complications for both the mother and fetus. Treatment of recalcitrant generalized PPP may be challenging as available therapeutic options are limited. We herein present a 24‐year‐old pregnant woman with generalized PPP accompanied by high fever, fatigue, leukocytosis, and elevated levels of serum acute phase reactants. The patient was resistant to a combination treatment of high‐dose cyclosporine (7.5 mg/kg/d, peroral), systemic methylprednisolone (1 mg/kg/d, intramuscular), and empirical antibiotherapy. However, she dramatically improved with infliximab (5 mg/kg, intravenous infusion), which was introduced at week 28 of pregnancy. Even within 24 hours after the first infusion of infliximab, pustular lesions began to regress with a rapid decline in fever. Following the third infusion, clearance of pustular lesions with a slight erythema was observed. Serum levels of leukocytes and acute phase reactants returned to normal. There were no adverse events related to infliximab therapy. At 40 weeks, the patient gave birth to a healthy baby. Our experience reported herein suggests that infliximab may serve as a rapidly acting, highly effective, and well‐tolerated “rescue” therapy in recalcitrant generalized PPP, which poses a big therapeutic challenge for clinicians.
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