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A 36-year-old Primigravida in Her 36th Week of Gestatin with Generalized Erythematous thin Plaques with Pustular Formation
Yu-Ju Shen , Gwo-Shing Chen , Chieh-Shan Wu
Dermatol Sinica 24:155-156,2006

Case Report
A 36-year-old primigravida in her 36th week of gestation was admitted to our
department with generalized erythematous thin plaques with pustular formation
(Fig.1). The skin eruption developed from left axillary region and then spreaded to the
whole body gradually in the past 5 to 6 weeks. She was neither taking any medication
regularly, nor was there any history of allergy to medication. There was no evidence
of psoriasis and other skin diseases known in her medical and family history.
Inspection of the her showed the eruption consisting of nummular and polycyclic
erythematous thin plaques covered with concentric rows of numerous pin-sized
pustules that formed annular borderline on the peripheral of the plaques. The plaques
extended centrifugally by new crops of pustules, and the central older pustules dried
with dirty-white scales. Thickening and onychodystrophy of the nails were found.
There was no involvement of her mucous membranes, except for lip vermillion that
had pustular formation (Fig. 2).
On hospitalization with this clinical picture, the patient had mild fever (38℃) and
general malaise. Besides the skin lesions, there was only pretibial edema found in
physical examination. The blood test showed mild increased white cell count
(10150/cu mm) with 86.7% neutrophils, elevated CRP level (96ug/ml) and decreased
serum albumin value (2.3mg/dl). Bacteriologic examination of the pus was negative.
Fetal heart rate monitor and ultrasonographic examination revealed no signs of acute
or chronic fetal distress.
The histopatholoy of the skin biopsy showed spongiotic dermatitis with numerous
neutrophils and lymphocytes infiltration among keratinocytes, which formed
multilocular intraepidermal and subcorneal microabscesses (Fig. 3&4). Perivascular
lymphocytic and neutrophilic infiltration in the dermis was also noted. No deposition
of IgG, IgM, IgA and complement was detected in direct immunofluorescence.

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