A Case Report of a Patient with Turner Syndrome, Multiple Comorbidities, and Pustular Psoriasis

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A Case Report of a Patient with Turner Syndrome, Multiple Comorbidities, and Pustular Psoriasis

Introduction

Psoriasis is a chronic inflammatory disease commonly seen in dermatologic practice, and its pathogenesis is attributed to Th-1 and Th-17 cell dysregulation among others . Besides the commonly seen rheumatologic issue of psoriatic arthritis, psoriasis has been shown to have an association with metabolic syndrome and its diagnostic components: obesity, insulin resistance, lipid abnormalities, high blood pressure, and related cardiovascular risk factors .

Particularly, this association has been found consistently in epidemiologic studies showing that patients with more severe psoriasis have an increased prevalence of metabolic syndrome than patients with mild psoriasis. Turner syndrome (TS) is a genetic condition representing a constellation of characteristic physical features in combination with completely or partially missing X chromosome in a female. TS’s associations with autoimmune diseases, including autoimmune skin disorders such as psoriasis, lichen planus, and alopecia areata, have previously been reported in the literature. Further, like psoriasis, TS has also been associated with multiple cardiovascular risks and comorbidities, including metabolic syndrome and DM2 especially in adults. In the current report, we present an adult patient with TS and multiple comorbidities which include metabolic syndrome and DM2 who developed pustular psoriasis

Case Presentation

A 53-year-old Hispanic woman with a mosaic Turner syndrome, presented with a one-week history of a sudden, mildly pruritic widespread rash. Prior to presenting at the University of Miami Department of Dermatology, the patient was seen in the emergency department and was discharged with a triamcinolone ointment which partially alleviated her symptoms. The patient denied a history of skin rashes, upper respiratory infection, constitutional symptoms, or arthralgias. She had numerous medical comorbidities, including hypertension (HTN), coronary artery disease (CAD) status-post stents, history of a cerebral vascular accident, hyperlipidemia (HLD), poorly controlled diabetes mellitus type II, and chronic kidney disease (CKD), which she took several medications for, including atenolol, rosuvastatin, clopidogrel, insulin, aspirin, losartan, ondansetron, and metformin. Yet, she denied any changes to her medication regimen for the past several years. Her past medical history was negative for multiple sclerosis, neurodegenerative disease, hepatitis, tuberculosis, or congestive heart failure.

Best Regards
Sarah Jhonson
Managing Editor
International Journal of Case Reports
Email: caserep@emedicalsci.org