A 54-year-old woman with invasive ductal carcinoma of the breast and well-controlled chronic plaque psoriasis presented to the emergency department with a 2-day history of painful rash and fever. Five days before the onset of the rash, the patient had completed a 2-week course of systemic glucocorticoids to treat side effects of chemotherapy. The body temperature was 38.2°C, and heart rate 137 beats per minute. On physical examination, widespread erythematous patches with overlying, coalescing pustules were seen on the torso, arms, legs, face, and scalp, with sparing of mucosal surfaces. Laboratory testing was notable for neutrophilic leukocytosis and an elevated C-reactive protein level. Biopsy of the rash in the periumbilical region revealed neutrophil-rich pustules in the epidermis on histopathological testing. What is the most likely diagnosis?
一名54岁女性，患有乳腺浸润性导管癌及控制良好的慢性斑块型银屑病，因皮疹伴疼痛及发热2天就诊于急诊科。该患者在皮疹出现前5天刚完成为期2周的全身糖皮质激素治疗，以应对化疗副作用。查体示体温38.2℃，心率137次/分。皮肤检查发现躯干、四肢、面部及头皮广泛分布红色斑片，其上可见融合性脓疱，黏膜表面未受累。实验室检查提示中性粒细胞增多及C反应蛋白升高。脐周皮疹活检组织病理学检查显示表皮内富含中性粒细胞的脓疱形成。最可能的诊断是：
A. Acute generalized exanthematous pustulosis急性泛发性发疹性脓疱病
B. Generalized pustular psoriasis泛发性脓疱型银屑病
C. IgA Pemphigus IgA天疱疮
D. Staphylococcal scalded skin syndrome葡萄球菌性烫伤样皮肤综合征
E. Subcorneal pustular dermatosis表皮下脓疱性皮肤病
答案解析：
诊断为泛发性脓疱型银屑病——这是一种罕见的自身炎症性皮肤病，表现为广泛分布的无菌性脓疱及全身症状。该病常发生于已有斑块型银屑病的患者中，可能自发出现，也可能由生理应激因素（如药物减停）诱发。
正确答案：B
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