Fernandes Merle, Vemuganti Geeta K, Rao Gullapalli N
Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, India.
Clin Exp Ophthalmol. 2007 Nov;35(8):763-6. doi: 10.1111/j.1442-9071.2007.01581.x.
A 21-year-old febrile lady presented to the emergency service with severe lid oedema, conjunctivitis, dry mouth and abdominal skin rash. Over 5 days, she developed silvery scales and pustules on the lids, and generalized pustules on an erythematous base. Multiple focal sterile corneal infiltrates were seen. Haematological investigations and a skin biopsy were done as the consulting dermatologist suspected acute generalized pustular psoriasis. In addition, secondary Sjögren's syndrome was diagnosed since she had keratoconjunctivitis sicca, xerostomia, raised erythrocyte sedimentation rate and positive antinuclear antibodies. The presence of microabscesses in the epidermis on skin biopsy confirmed the diagnosis of pustular psoriasis. With oral methotrexate 7.5 mg weekly and topical corticosteroids, the acute condition gradually resolved; however, the keratoconjunctivitis sicca is persisting. Secondary Sjögren's syndrome associated with acute generalized pustular psoriasis and ocular psoriasis is extremely rare. Awareness of the ocular and dermatological features of these two conditions would result in earlier diagnosis and institution of appropriate treatment.
一名21岁发热女性因严重眼睑水肿、结膜炎、口干及腹部皮疹就诊于急诊科。5天内，她的眼睑出现银色鳞屑和脓疱，全身出现以红斑为基底的脓疱。可见多处局灶性无菌性角膜浸润。由于会诊皮肤科医生怀疑为急性泛发性脓疱型银屑病，进行了血液学检查和皮肤活检。此外，由于她患有干燥性角结膜炎、口干、红细胞沉降率升高及抗核抗体阳性，诊断为继发性干燥综合征。皮肤活检显示表皮有微脓肿，确诊为脓疱型银屑病。每周口服甲氨蝶呤7.5毫克及外用糖皮质激素后，急性症状逐渐缓解；然而，干燥性角结膜炎仍持续存在。与急性泛发性脓疱型银屑病和眼型银屑病相关的继发性干燥综合征极为罕见。了解这两种疾病的眼部和皮肤特征将有助于早期诊断并采取适当治疗。
