Central nervous system dysmyelination in PIBI(D)S syndrome: A further case

none2noneBATTISTELLA PA; A. PESERICO STECCHINI NEGRI DE SALVIBattistella, PIER ANTONIO; PESERICO STECCHINI NEGRI DE SALVI, Andre

Kobner phenomenon in psoriasis induced by Mantoux test

The Koebner phenomenon refers to the appearance of a dermatosis at sites of trauma or other cutaneous injuries. We describe a case of psoriatic flare-up developing from the site of the Mantoux test and subsequently spread to the entire body surface, with development of pustular lesions. A 58-year-old man presented with a 37-year history of severe plaque-type psoriasis. The patient was also affected by marked hypercholesterolemia, chronic gastritis and hypertension. Over time, he had been treated with multiple therapies including phototherapy with narrowband UVB, systemic corticosteroids and cyclosporine. Cyclosporine at 350 mg/day was the only effective approach, but it had to be discontinued after 1 month because of the uncontrolled worsening of hypertension. At presentation, the patient showed multiple plaques, well defined, characterized by mild infiltration, moderate erythema and coarse scaling, covering approximately 20% of body surface area, with a Psoriasis Area Severity Index (PASI) score of 14.6 and a Nail Psoriasis Severity Index of 6. Since the patient suffered from several comorbidities and he had previously shown to be unresponsive to narrowband UVB phototherapy, we considered a biologic therapy. We thus collected personal history and performed physical examination, laboratory tests and a screening for tuberculosis. The chest radiography was negative. A Mantoux test performed on his left forearm revealed a positive reaction (> 10 mm). Two days after, the patient developed a psoriatic plaque at the site of the Mantoux test (Fig. 1). One week after the Mantoux test, the patient showed a severe worsening of psoriasis on the entire body surface. Suddenly, the previously observed lesions enlarged and new psoriatic plaques developed on healthy skin sites resulting in an almost generalized involvement of body surface area (Fig. 2). The lesions were deeply infiltrated and severely erythematous. PASI score was 32.6 and BSA was 80%. Within some of these plaques, scattered pustules were detected. The patient denied to have ever suffered from pustular psoriasis