Question

A patient diagnosed with psoriasis was put on treatment with high dose dexamethasone for 2 weeks. The patient stopped treatment after which he develops high-grade fever and generalized pustular lesions all over his body. What is the most likely diagnosis?

• A. Septicaemia
• B. Drug reaction
• C. Pustular psoriasis
• D. Secondary bacterial infection

Hint:

Abrupt steroid withdrawal in a psoriasis patient can trigger generalized pustular psoriasis (von Zumbusch type).

Answer 1

The Correct Option is C

Step 1: Note the key trigger in the history.
The patient already has psoriasis and was given a high dose systemic steroid, then stopped it abruptly after 2 weeks. Sudden withdrawal of systemic steroids in a psoriasis patient is a well known trigger for a flare.

Step 2: Recall what steroid withdrawal does in psoriasis.
Steroids suppress the immune activity driving psoriasis while they are given. Stopping them abruptly removes that suppression fast, and the disease rebounds, often in a more severe form than before treatment started.

Step 3: Match the rebound to its severe form.
In some patients this rebound takes the form of generalized pustular psoriasis (the von Zumbusch pattern), with widespread sheets of small sterile pustules, high-grade fever, and a feeling of being very unwell. This is exactly the picture described.

Step 4: Rule out the other options.
Septicaemia would show positive blood cultures and a source of infection, not a clean trigger of steroid withdrawal in a known psoriasis patient. A drug reaction usually appears after starting a new drug, not after stopping one, and does not typically produce this pustular pattern. Secondary bacterial infection would show pus that grows organisms on culture and usually starts at a local site, not as a sudden generalized eruption right after steroid withdrawal.

Final Answer:
The most likely diagnosis is
\[ \boxed{\text{Pustular psoriasis (generalized, von Zumbusch type)}} \]