We present a 64-year-old woman with past medical history of
psoriasis and
alcoholic liver cirrhosis who presented with a diffuse, erythematous, and scaly
rash. Pertinent medications included topical
triamcinolone 0.1% cream. She was started on oral
prednisone 40 milligrams (mg) and oral
cyclosporine 150 mg daily and was continued on topical
triamcinolone. After the administration of two doses of this regimen, the serum
creatinine increased to 1.76 mg/dL, and serum
potassium increased to 6.7 mEq/L. The serum
creatinine continued to uptrend to 2.42 mg/dL, and the glomerular filtration rate (GFR) decreased to 20 mL/min. The patient was emergently hemodialyzed. The patient was placed on an extended
steroid taper, alleviating the psoriatic
rash. However, the patient needed to be placed on a
steroid-sparing regimen. Because of its rarity and ensuing complications, erythrodermic
psoriasis must be identified and managed promptly.
Cyclosporine is currently the first-line treatment. However, initiation of this
therapy in our patient resulted in an
acute kidney injury (AKI). Even though a
steroid taper assisted in alleviating
erythroderma, a
steroid-sparing regimen needed to be started. This led to the consideration of alternate methods of
therapy for further management of erythrodermic
psoriasis with renal impairment.