Paraneoplastic Papuloerythroderma of Ofuji Masquerading as Worsening Psoriasis

Paraneoplastic papuloerythroderma of Ofuji (PEO) is a rare cause of exfoliative erythroderma characterized by intensely pruritic, generalized erythema and scale with relative sparing of the skin folds (deck-chair sign) and is frequently associated with underlying malignancy, most commonly cutaneous T-cell lymphoma (CTCL). We present a unique case of paraneoplastic PEO in a patient with a history of plaque psoriasis whose rash suddenly began to worsen despite treatments for psoriasis. He developed diffuse brightly erythematous plaques with sparing fo the skin folds and hyperkeratotic, fissured plaques on the palms and soles. This ultimately led to hospitalization for erythroderma. Upon further work up, he was found to have squamous cell carcinoma of the lung by computed tomography. This case underscores that abrupt erythrodermic worsening in a patient with known psoriasis should prompt evaluation for an underlying paraneoplastic process rather than being attributed to psoriasis progression alone.