Question:medium
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 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?
Show Hint
Abrupt steroid withdrawal in a psoriasis patient can trigger generalized pustular psoriasis (von Zumbusch type).
Updated On: Jul 8, 2026
- Septicaemia
- Drug reaction
- Pustular psoriasis
- Secondary bacterial infection
Show Solution
The Correct Option is C
Solution and Explanation
Step 1: Understanding the Question:
A known psoriasis patient took high dose dexamethasone for two weeks, stopped it, and then had fever with pustules covering the body. We need to name this reaction.
Step 2: Key Formula or Approach:
Remember one rule for psoriasis: never stop systemic steroids suddenly. Abrupt withdrawal is a classic trigger for the disease to flare back, sometimes turning into its pustular form.
Step 3: Detailed Explanation:
While the steroid is running, it dampens the immune drive behind psoriasis. Once it is pulled away quickly, that immune drive comes back stronger than before, and in some patients the skin responds with generalized pustular psoriasis, showing crops of tiny sterile pustules across the body along with high fever and feeling generally unwell. This matches the case exactly: a known psoriatic, steroid stopped abruptly, then fever plus generalized pustules. Septicaemia would need a source of infection and positive cultures, which is not mentioned. A drug reaction is more typical after starting a new drug, not stopping one. A secondary bacterial infection would usually start locally and grow organisms on culture, not erupt everywhere at once right after steroid withdrawal.
Step 4: Final Answer:
The pattern fits generalized pustular psoriasis triggered by steroid withdrawal.
\[ \boxed{\text{Pustular psoriasis}} \]
A known psoriasis patient took high dose dexamethasone for two weeks, stopped it, and then had fever with pustules covering the body. We need to name this reaction.
Step 2: Key Formula or Approach:
Remember one rule for psoriasis: never stop systemic steroids suddenly. Abrupt withdrawal is a classic trigger for the disease to flare back, sometimes turning into its pustular form.
Step 3: Detailed Explanation:
While the steroid is running, it dampens the immune drive behind psoriasis. Once it is pulled away quickly, that immune drive comes back stronger than before, and in some patients the skin responds with generalized pustular psoriasis, showing crops of tiny sterile pustules across the body along with high fever and feeling generally unwell. This matches the case exactly: a known psoriatic, steroid stopped abruptly, then fever plus generalized pustules. Septicaemia would need a source of infection and positive cultures, which is not mentioned. A drug reaction is more typical after starting a new drug, not stopping one. A secondary bacterial infection would usually start locally and grow organisms on culture, not erupt everywhere at once right after steroid withdrawal.
Step 4: Final Answer:
The pattern fits generalized pustular psoriasis triggered by steroid withdrawal.
\[ \boxed{\text{Pustular psoriasis}} \]
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