SARS-CoV-19 and Generalised Pustular Psoriasis: A Lethal Combination

Generalised pustular psoriasis(GPP) is a rare, potentially life-threatening variant of psoriasis with acute onset, widely spread pustular lesions on an inflamed base associated with a systemic inflammatory state. In the setting of the current COVID-19 pandemic, flares in pustular psoriasis have been reported, however these flares leading to mortality in SARS-CoV-2 infected patients is hitherto unreported. We present two cases of GPP flare following SARS-CoV-2 infection with fatal outcome. A 20 year old male, known case of GPP since 5 years presented with an exacerbation of his existing disease for 2 months. He had received methotrexate, cyclosporine, acitretin, apremilast, infliximab and secukinumab in the past. He was admitted and started on inj. methotrexate (subcutaneous) and cap. acitretin. During admission, he developed COVID-19 associated severe acute respiratory distress syndrome(ARDS). Despite timely intervention with life-saving measures, the patient could not be saved. The second case was a 52-year-old female, a case of GPP on treatment for the last 10 years, being maintained on cap. acitretin and cyclosporine. She also developed ARDS due to COVID infection. Despite being on acitretin for GPP and the appropriate management of severe COVID infection, her condition worsened and she expired within one day of admission. Both of our patients were not vaccinated against COVID-19. Awareness of potential risk of mortality in patients of GPP getting co-infected by COVID-19 is thus essential for dermatologists.