BMJ Case Reports 2018; doi:10.1136/bcr-2017-223475
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

ARDS complicating pustular psoriasis: treatment with low-dose corticosteroids, vitamin C and thiamine

  1. Ashleigh Long
  1. Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
  1. Correspondence to Dr Paul Ellis Marik, marikpe{at}
  • Accepted 14 January 2018
  • Published 2 February 2018


We report the case of a 45-year-old Caucasian woman with a history of psoriasis, admitted to our Medical intensive care unit following the acute onset of diffuse rash and progressive dyspnoea and hypoxaemia requiring escalating respiratory support (continuous positive airway pressure of 10 cm H2O). Her chest X-ray was consistent with findings of non-cardiogenic pulmonary oedema. Echocardiogram was normal. Dermatology considered her skin lesions to be consistent with psoriasis vulgaris with pustular flare. In the absence of an identifiable cause for her respiratory failure, she was diagnosed with acute respiratory distress syndrome due to her psoriatic flare. Treatment with cyclosporine was initiated together with low-dose systemic corticosteroids, intravenous vitamin C and thiamine. The patient made a dramatic recovery being weaned to nasal cannulae within 24 hours after the initiation of this treatment protocol and was discharged home a few days later.


  • Contributors PEM was the specialist involved in the management of the patient and made the decision to treat the patient with the ‘metabolic resuscitation protocol’; was involved in the acquisition and interpretation of the patient data; reviewed the literature of ARDS complicating pustular psoriasis; and reviewed and edited the drafts of the manuscript. AL was responsible for the acquisition of the patient data; was responsible for collating the patient information including the photograph of the skin lesions; reviewed the literature on this topic; was responsible for writing the first draft of the manuscript; was responsible for follow-up discussion with the patient and obtaining consent to publish the case report; and approved the final version of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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