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April 2013

Palmoplantar Pustulosis Presenting With Chest Pain—Quiz Case

JAMA Dermatol. 2013;149(4):475-480. doi:10.1001/jamadermatol.2013.1998a

A 45-year-old man presented with a 2-week history of mildly pruritic erythematous lesions on both palms and soles. He also complained of constant chest pain that worsened with movement. His family medical history was unremarkable, and he had no clinically significant medical history or previous trauma. Physical examination revealed multiple mildly itchy pustules on both palms and soles (Figure 1). Manipulation of the joints in his anterior chest wall elicited discomfort. Laboratory evaluations, including complete blood cell count, basic chemistry profiles, and cardiac enzyme analyses yielded normal results. Chest radiography and electrocardiography results were normal. Bacterial cultures of the pustules yielded negative results. Bone scintigraphy (Figure 2) and punch biopsy were performed. The histologic findings are shown in Figure 3.