1316 - Severe Generalized Pustular Psoriasis Complicated by Sepsis and Multiorgan Dysfunction: A Case Report and Rehabilitation Perspective

Generalized pustular psoriasis with multiorgan dysfunction

Case Description: A 59-year-old female with obesity, rheumatoid arthritis, and psoriasis presented with a two-day history of worsening rash and bilateral knee pain. Vitals showed fever, hypotension, and tachycardia. Examination revealed eroded violaceous papules and plaques with dark borders and scaling on the face, trunk, and extremities. Laboratory studies demonstrated leukocytosis, lactic acidosis, rhabdomyolysis, acute kidney injury, and elevated troponin and inflammatory markers. She was admitted for sepsis, renal failure prompting hemodialysis, and concern for demand ischemia. Dermatology biopsy confirmed generalized pustular psoriasis (GPP). She received spesolimab followed by ixekizumab with clinical improvement. After stabilization, she was transferred to inpatient rehabilitation. During rehabilitation, she made improvements with wheelchair mobility, transfers, and standing tasks, and was discharged safely to a skilled nursing facility.

Discussions: This case illustrates a fulminant GPP flare with multiorgan dysfunction. Pustular psoriasis is a rare, severe variant characterized by sterile pustules on an erythematous base. GPP is a potentially life-threatening systemic inflammatory disease with recurrent flares, often triggered by corticosteroid withdrawal, infection, and metabolic derangements. Complications include sepsis, renal failure, cardiac involvement, and hepatic dysfunction. Management options include the IL-36 receptor antagonist spesolimab, biologics targeting TNF-α, IL-17, or IL-23, and systemic agents such as acitretin, cyclosporine, or methotrexate. Early dermatologic input and targeted therapy are essential to prevent further organ injury, reduce morbidity, and limit unnecessary interventions. Long-term care emphasizes disease control and quality of life. Inpatient rehabilitation also played a pivotal role, facilitating functional recovery despite medical complexity.

Conclusions: GPP may present as a systemic inflammatory syndrome with multiorgan involvement, delaying diagnosis and complicating care. Timely dermatology consultation, appropriate biologic therapy, and coordinated rehabilitation are necessary to halt progression, support recovery, and preserve independence despite its relapsing course.