Generalized pustular psoriasis with a novel mutation of interleukin-36 receptor antagonist, responding to methotrexate Yee-Leng Teoh, MD, MRCP, Yong-Kwang.

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Generalized pustular psoriasis with a novel mutation of interleukin-36 receptor antagonist, responding to methotrexate Yee-Leng Teoh, MD, MRCP, Yong-Kwang Tay, MD, FRCP JAAD Case Reports Volume 1, Issue 2, Pages 51-53 (March 2015) DOI: 10.1016/j.jdcr.2014.12.007 Copyright © 2015 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 A, Scattered discrete pustules on erythematous skin on the shins. B, Dystrophic toenails with pustules on both feet. JAAD Case Reports 2015 1, 51-53DOI: (10.1016/j.jdcr.2014.12.007) Copyright © 2015 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 Skin biopsy results showed acanthosis, elongated rete processes, spongiosis, and focal parakeratosis. Neutrophils migrate through the epidermis and concentrate in the parakeratotic layer. It has perivascular inflammation and includes neutrophils, lymphocytes, plasma cells, and some eosinophils. Extravasation of red blood cells is noted in the papillary dermis. (Hematoxylin-eosin stain; original magnification: ×40.) JAAD Case Reports 2015 1, 51-53DOI: (10.1016/j.jdcr.2014.12.007) Copyright © 2015 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Homozygous point mutation in which the cytosine pyrimidine was substituted with the thymine pyrimidine in the splicing donor site on the region of exon 3. JAAD Case Reports 2015 1, 51-53DOI: (10.1016/j.jdcr.2014.12.007) Copyright © 2015 American Academy of Dermatology, Inc. Terms and Conditions