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Widespread pustular eruption following probiotic use

  • Author(s): Price, Kyla N
  • Hendricks, Aleksi J
  • Goodrich, Mackenzie E
  • Krase, Jeffrey M
  • Shi, Vivian Y
  • et al.
Creative Commons 'BY-NC-ND' version 4.0 license
Abstract

A 26-year-old woman with Crohn disease and palmoplantar psoriasis on ustekinumab presented with a diffuse and intensely pruritic rash with a few pin-point pustules within days after initiation of an over-the-counter Align brand probiotic. Biopsy revealed psoriasiform and spongiotic dermatitis with spongiform subcorneal pustules and scattered eosinophils, consistent with acute generalized exanthematous pustulosis. Our case highlights a unique presentation of acute generalized exanthematous pustulosis following probiotic exposure with fewer than usual pustular lesions. IL23 suppression by ustekinumab may have contributed to the patient's reduced pustular presentation.

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