CT scan and magnetic resonance imaging of the spine revealed a prevertebral mass at the level of the 7th and 8th thoracic vertebrae. The CT scan-guided biopsy was inconclusive, and he underwent an open biopsy that showed aseptic osteomyelitis with periosteal fibrosis and new bone formation. Discussion Pulmonary hemosiderosis has been reported in some cases with an immune etiology 5 associated with collagen vascular diseases, or as an early manifestation of a systemic vasculitis. 6 Previous reports of pulmonary inflammation coincident with generalized pustular psoriasis 7,8 were diagnosed as sterile pneumonitis or unexplained alveolar shadowing on x-ray. It has been proposed that pulmonary inflammation coincident with extensive cutaneous disease might result from the action of epidermal cell-derived inflammatory mediators on the pulmonary vasculature.
Cytokines are important mediators of pulmonary inflammation.
This immune-mediated mechanism was proposed by McGregor and colleagues 9 to be the probable cause of the development of increased pulmonary vascular permeability in their two patients. We speculate that this immune-mediated mechanism might also account for alveolar hemorrhage in our case. The hemorrhage appeared coincident with exacerbations of GPP, leading to recurrent respiratory symptoms in our patient. Bone x-ray showing lytic lesions. The suggested logical explanation for their action is that they block production of pro-inflammatory cytokines, adhesion molecules and chemotoxins by KCs and immunocytes.