Division of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR.
Dermatol Online J. 2020 Nov 15;26(11):13030/qt7gz2d8t0.
A 26-year-old woman with Crohn disease and palmoplantar psoriasis on ustekinumab presented with a diffuse and intensely pruritic rash with a few pin-point pustules within days after initiation of an over-the-counter Align brand probiotic. Biopsy revealed psoriasiform and spongiotic dermatitis with spongiform subcorneal pustules and scattered eosinophils, consistent with acute generalized exanthematous pustulosis. Our case highlights a unique presentation of acute generalized exanthematous pustulosis following probiotic exposure with fewer than usual pustular lesions. IL23 suppression by ustekinumab may have contributed to the patient's reduced pustular presentation.
一位 26 岁女性患有克罗恩病和掌跖银屑病，在使用乌司奴单抗治疗后数天内开始使用非处方 Align 品牌益生菌后，出现弥漫性强烈瘙痒皮疹，并伴有少量针尖状脓疱。活检显示银屑病样和海绵状皮炎，伴有海绵状角质下脓疱和散在的嗜酸性粒细胞，符合急性泛发性发疹性脓疱病。我们的病例突出了急性泛发性发疹性脓疱病在接触益生菌后出现的一种独特表现，脓疱病变少于通常情况。乌司奴单抗抑制 IL23 可能导致患者脓疱病变减少。
