A rare case of pustular psoriasis in the first trimester of pregnancy

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Background. Pustular psoriasis of pregnancy (PPP), also referred to as impetigo herpetiformis, is a rare and potentially severe dermatosis of pregnancy that may be associated with maternal systemic symptoms and adverse fetal outcomes. Presentation in the first trimester is uncommon and may pose diagnostic and therapeutic challenges. Case presentation. We report the case of a 21-year-old pregnant woman, G1P0A0, at 15 weeks’ gestation, who developed a rapidly progressive eruption of erythematous plaques with clusters of sterile-appearing pustules, with onset 8 weeks earlier, at approximately 7 weeks’ gestation. The eruption involved the face, trunk, and extremities, with prominent erythematous scaly plaques and micropustules. Skin biopsy was declined. Laboratory evaluation showed inflammatory and nutritional abnormalities, including neutrophilia, elevated erythrocyte sedimentation rate, hypoalbuminemia, and anemia; autoimmune screening revealed only mildly elevated antinuclear antibody levels. Based on the clinical pattern, pregnancy context, and assessment of key differential diagnoses, PPP was considered the most likely diagnosis. Management and outcome. The patient received supportive care and topical therapy, including a topical corticosteroid, wet dressings, and emollient/urea treatment. During the subsequent course, she developed fever and required hospitalization at another facility. The pregnancy ended in spontaneous miscarriage at 17 weeks’ gestation. Given the limited external documentation and lack of histopathologic confirmation, a causal relationship between the dermatosis and pregnancy loss could not be established. Conclusion. This case highlights the importance of early recognition of PPP in pregnancy, systematic evaluation of differential diagnoses when biopsy is not feasible, and close multidisciplinary maternal-fetal monitoring, as clinical deterioration may occur and outcomes can be unfavorable.

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