Poststreptococcal Pustulosis
A 47-year-old man presented to the ER with a 3-day history of a pustular rash that had developed on both hands. One week prior, he had started treatment with penicillin V potassium for pharyngitis. A throat-swab culture grew group A β-hemolytic streptococcus. CLINICAL PRESENTATION: Physical examination revealed multiple pustules surrounded by an erythematous rim on the palms of both hands and on the soles of both feet. Laboratory test results showed an absolute neutrophil count of 14,900 per cubic millimeter and a C-reactive protein level of 30 mg per liter; renal function was normal. A punch biopsy specimen of a palmar lesion was obtained, and histopathological analysis revealed a subcorneal pustule and mononuclear-cell infiltrates in the dermis. These findings were consistent with poststreptococcal pustulosis, an uncommon complication of group A streptococcal infection that may be misdiagnosed as palmoplantar psoriasis or acute generalized exanthematous pustulosis. TREATMENT : Topical treatment with clobetasol was initiated, and the rash resolved after 14 days. At the 1-year follow-up visit, the patient had no recurrence of the rash. Credits: https://www.nejm.org/doi/full/10.1056/NEJMicm2002486
Wow, this is not something focused on. Great case! Now we can add PP to "hands and feet rashes"
Thank you sharing. I enjoyed learning the differentiating analysis of the Streptococcal infection can easily be misdiagnosed. Very interesting!
Is it drug induced ,? Even though it was due to streptococcal induced ,in GP very tough to convince the pt.
Good mate, but what about low dose of cephalosporine 50 mg daily for 3 days then 25 mg daily for 3 days. Cephalosporine has a rapid action and less hyperglycemic side effect in comparison to corticosteroids. However nice case