British Journal of Dermatology (1976) 94, 105.

Brief Communication Generalized pustular psoriasis associated with chronic renal failure J U L I A N V E R B O V Broadgreen Hospital, Liverpool L14 3LB

A male aged 61 years known to be suffering from chronic renal failure due to polycystic kidneys (the latter diagnosed in 1963) was admitted to hospital on 10 March 1975 dyspnocic and in gross congestive cardiac failure. He gave a 4-week history of dyspnoea and for 2 weeks had had an asymptomatic eruption which had started over the neck and had spread to trunk and limbs. When seen on 12 March he showed extensive erythema with many areas showing pin-poitit sized sterile pustules either in sheets, rings, or in small patches {Fig. i). The clinical picture suggested generalized pustular psoriasis

FIGURE I. Puiiiulcs over Iclt thjgii.

and histology (showing spongiform pustules of Kogoj) confirmed this, although the patient gave neither a personal nor a family history of psoriasis. He received peritoneal dialysis in addition to other therapy including bland topical skin applications, but although his skin improved wi± desquamation within 10 days of admission, he deteriorated generally and died on 31 March. Investigations. Two months before adtnission his blood urea was 172 mg/ioo ml, scrum calcium 9-6 mg/ioo ml, serum albumin 3-9 g/roo ml. By 27 March his blood urea had risen to 416 mg/ioo ml, with serum calcium 7-8 tng/ioo ml, serum albutnin 2-4 g/ioo m\; the hypocalcaemia is explained by the low serum albumin (to which calcium is bound). This patient is of interest because his first appearance of psoriasis at the age of 61 was acute and of the generalized pustular form and occurred when he was in terminal renal failure associated with hypocalcaemia. In tny opinion the hypocalcaemia precipitated his pustular psoriasis. Acknowledgment

I should like to thank Dr W.H.R.Cook for asking me to see this patient. 105

Generalized pustular psoriasis associated with chronic renal failure.

British Journal of Dermatology (1976) 94, 105. Brief Communication Generalized pustular psoriasis associated with chronic renal failure J U L I A N V...
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