PUSTULAR AND ERYTHRODERMIC PSORIASIS COMPLICATED BY ACUTE RESPIRATORY-DISTRESS SYNDROME

Background: The pustular and erythrodermic types of psoriasis have bee n associated with a number of systemic complications, including conges tive heart failure and pneumonia. Acute respiratory distress syndrome (ARDS) refers to acute noncardiogenic pulmonary edema with hypoxemia o f various causes and has been attributed to pulmonary capillary leak. Recently, 4 cases of generalized pustular or erythrodermic psoriasis h ave been described associated with a pulmonary capillary leak syndrome . Observations: We describe 2 additional patients, 1 with pustular and erythrodermic psoriasis and 1 with erythrodermic psoriasis, who devel oped ARDS. Radiographic findings, pulmonary capillary wedge pressures, echocardiograms, and, in one case, an open lung biopsy specimen, were consistent with the diagnosis of ARDS. In neither case could we docum ent any of the common causes of acute respiratory failure. Conclusions : Generalized pustular and erythrodermic psoriasis may be complicated by ARDS. The pathogenesis of this complication is unclear, but proinfl ammatory cytokines may be involved.