Rao Suman, Bernshteyn Michelle, Sohal Raman, Proumen Rachael, Goodman Alexandra, Shepherd Zachary
SUNY Upstate Medical University Hospital, 750 E Adams St., Syracuse, NY 13210, USA.
Case Rep Dermatol Med. 2020 Sep 8;2020:5215478. doi: 10.1155/2020/5215478. eCollection 2020.
We present a 64-year-old woman with past medical history of psoriasis and alcoholic liver cirrhosis who presented with a diffuse, erythematous, and scaly rash. Pertinent medications included topical triamcinolone 0.1% cream. She was started on oral prednisone 40 milligrams (mg) and oral cyclosporine 150 mg daily and was continued on topical triamcinolone. After the administration of two doses of this regimen, the serum creatinine increased to 1.76 mg/dL, and serum potassium increased to 6.7 mEq/L. The serum creatinine continued to uptrend to 2.42 mg/dL, and the glomerular filtration rate (GFR) decreased to 20 mL/min. The patient was emergently hemodialyzed. The patient was placed on an extended steroid taper, alleviating the psoriatic rash. However, the patient needed to be placed on a steroid-sparing regimen. Because of its rarity and ensuing complications, erythrodermic psoriasis must be identified and managed promptly. Cyclosporine is currently the first-line treatment. However, initiation of this therapy in our patient resulted in an acute kidney injury (AKI). Even though a steroid taper assisted in alleviating erythroderma, a steroid-sparing regimen needed to be started. This led to the consideration of alternate methods of therapy for further management of erythrodermic psoriasis with renal impairment.
我们报告了一名64岁女性，有银屑病和酒精性肝硬化病史，出现弥漫性、红斑性和鳞屑性皮疹。相关用药包括外用0.1%曲安奈德乳膏。开始给予她口服泼尼松40毫克（mg）和口服环孢素150毫克/天，并继续外用曲安奈德。在使用该方案两剂后，血清肌酐升至1.76毫克/分升，血清钾升至6.7毫当量/升。血清肌酐继续上升至2.42毫克/分升，肾小球滤过率（GFR）降至20毫升/分钟。患者紧急接受血液透析。患者接受了延长的类固醇减量治疗，银屑病皮疹得到缓解。然而，患者需要采用类固醇节省方案。由于红皮病型银屑病罕见且会引发并发症，必须及时识别并处理。环孢素目前是一线治疗药物。然而，在我们的患者中开始使用这种疗法导致了急性肾损伤（AKI）。尽管类固醇减量有助于缓解红皮病，但仍需要开始使用类固醇节省方案。这促使我们考虑采用替代治疗方法来进一步管理伴有肾功能损害的红皮病型银屑病。
