A Case Report of a Patient with Turner Syndrome, Multiple Co
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A 53-year-old Hispanic woman with a mosaic Turner syndrome, presented with a one-week history of a sudden, mildly pruritic widespread rash. Prior to presenting at the University of Miami Department of Dermatology, the patient was seen in the emergency department and was discharged with a triamcinolone ointment which partially alleviated her symptoms.

The patient denied a history of skin rashes, upper respiratory infection, constitutional symptoms, or arthralgias. She had numerous medical comorbidities, including hypertension (HTN), coronary artery disease (CAD) status-post stents, history of a cerebral vascular accident, hyperlipidemia (HLD), poorly controlled diabetes mellitus type II, and chronic kidney disease (CKD), which she took several medications for, including atenolol, rosuvastatin, clopidogrel, insulin, aspirin, losartan, ondansetron, and metformin. Yet, she denied any changes to her medication regimen for the past several years. Her past medical history was negative for multiple sclerosis, neurodegenerative disease, hepatitis, tuberculosis, or congestive heart failure.

The physical examination revealed a generalized eruption of well-demarcated pink papules and plaques, with fine scale and central clearing (Figures 1(a) and 1(b)), involving approximately 10% of the body surface area and mostly lower extremities, back, left axilla, and chest. No lymphadenopathy, nail or mucosal involvement was noted. There was no joint erythema or swelling. Notable laboratory findings included negative antistreptolysin O and anti-DNAse B antibodies and a normal level of serum calcium.

Skin biopsy was obtained and demonstrated scale/crust with a collection of neutrophils between parakeratotic layers, a mild psoriasiform hyperplasia with a reduced granular layer, and mild sparse chronic inflammatory infiltrate in dermis, which is consistent with pustular psoriasis.

The patient appeared to partially respond to topical therapy given at the emergency department, and her more affected areas were treated with clobetasol 0.05% ointment twice a day and her less bothersome areas were treated with triamcinolone 0.1% ointment twice a day.

Moreover, treatment also included a narrow band UVB phototherapy which was administered twice a week, while additional work-up including hepatitis panel, quantiferon, CBC, and CMP was obtained in anticipation of potential biologic therapy. Screening labs for possible biologic therapies were negative; however, the patient demonstrated significant improvement and resolution of skin lesions and symptoms after seven narrow-band UVB phototherapy sessions, thus hindering the need for more aggressive treatment.

Source: https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6970507/