CASE REPORT article
Front. Pediatr.
Sec. Pediatric Rheumatology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1652376
This article is part of the Research TopicExploring Innovative Therapies for Rare Inflammatory Skin DiseasesView all 17 articles
Case Report:Hydroxychloroquine-Induced Generalized Pustular Psoriasis in a Pediatric Patient with Systemic Lupus Erythematosus
Provisionally accepted
- Department of Pediatric Nephrology and Rheumatism and Immunology, Children's Hospital Affiliated to Shandong University, Jinan, China
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Hydroxychloroquine (HCQ) therapy is the main treatment for systemic lupus erythematosus (SLE); however, rare adverse effects, including generalized pustular psoriasis (GPP), have been predominantly reported in adults. We herein report the first case of GPP caused by HCQ in a pediatric SLE patient.A 7-year-old girl with SLE developed fever, hepatic dysfunction, and disseminated pustules 3 weeks after starting HCQ. Histopathological examination revealed the characteristic features of GPP, including epidermal hyperkeratosis with parakeratosis, pustule formation above the stratum spinosum and acanthosis. Neutrophils and lymphocytes were observed in the superficial and mid-dermal vascular plexuses.HCQ therapy was discontinued, and the patient received methylprednisolone, intravenous immunoglobulin, meropenem, and hepatoprotective therapy. After 9 days of treatment, the pustules had largely resolved and inflammatory markers had returned to normal. This unprecedented pediatric observation underscores HCQ as a potential trigger for GPP in pediatric patients with SLE and highlights the importance of immediate HCQ discontinuation for optimal outcome. Interleukin-17 and interleukin-36 cytokine pathways may synergistically contribute to pathogenesis, suggesting a role for targeted therapies.
Keywords: generalized pustular psoriasis, Hydroxychloroquine, systemic lupus erythematosus, pediatric, Adverse Drug Reaction
Received: 23 Jun 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Wang, Dong, Qiu, Xu, Kong and Zhou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weiran Zhou, weiranxue2014@163.com
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