A 37-year-old woman with a history of palmoplantar pustulosis presented with severe chest pain. The patient was first diagnosed with palmoplantar pustulosis at the age of 36 and soon afterwards suffered from upper chest pain. Although the pain and skin lesion had been relieved for three years after excision of the left first sternocostal articulation, she experienced subsequent relapse of sternal pain and palmoplantar pustulosis. Medication for rheumatoid arthritis, such as prednisolone, bucillamine, and methotrexate, or antibiotic therapy failed to ameliorate the symptoms. At the age of 45, she underwent palatine tonsillectomy with resolution of symptoms. At present, the patient has neither palmoplantar skin lesions nor sternal pain.
symmetric thick scaly red acral plaques studded with pustules