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Generalized pustular psoriasis associated with systemic lupus erythematosus successfully treated with secukinumab

Dear Editor, A 38-year-old Japanese woman presented with a 3-week history of recurrent itchy erythema with scales and sterile pustules on the trunk (Fig. 1a,b). She had been diagnosed with systemic lupus erythematosus (SLE), which manifested with antinuclear antibody positivity (1:640 homogenous and speckled), a high anti-dsDNA antibody titer (>300 IU/mL), polyarthritis and pericarditis 5 years previously. This was controlled with prednisolone sodium succinate (5 mg). She had no history of psoriasis vulgaris. She reported that itchy erythema with scales and a few pustules had developed during her second pregnancy, which was ameliorated by increasing the prednisolone doses and topical corticosteroids and disappeared after childbirth. A skin biopsy from a pustular lesion on the back showed Kogoj’s spongiform pustules (Fig. 1c,d). Direct and indirect immunofluorescence staining were negative. Topical corticosteroid treatment partially relieved the skin symptoms. Eight months later, she developed a fever of 39°C, and her erythema rapidly expanded and coalesced into erythematous skin lesions with numerous sterile pustules on the trunk and extremities (Fig. 1e,f). A laboratory examination revealed a normal total white blood cell count (6130/μL) (neutrophils, 72.0