A patient with psoriatic arthritis due to generalized pustular psoriasis (von Zumbusch type)

Pustular psoriasis is a rare skin disease that is observed in about 1% of all patients with psoriasis. We encounted a patient with psoriatic arthritis (PsA) due to pustular psoriasis. The patient was a 31-year old male. He visited our hospital due to generalized eruption and pain in multiple joints. Treatment was initiated under a diagnosis of psoriasis vulgaris and associated PsA. However, eruption extended to the entire body and became pustular, and fever developed. Since PsA symptoms were simultaneously aggravated, and body movements become difficult, he was admitted. A diagnosis of generalized pustular psoriasis (von Zumbusch) and associated symmetrical polyarthritis was made. Local therapy was performed. As systemic treatment, oral administration of an corticosteroid and weekly low-dose pulse methotrexate therapy were performed. The skin symptoms and PsA symptoms rapidly improved. At present, about one year after the initiation of treatment, the eruption almost completely disappeared, and joint pain does not present any problem in daily life.