Palmoplantar pustulosis and chest pain

A 32-year-old man presented to the emergency department with 1-month history of continuous chest pain, which was worse with movement and on application of pressure to the anterior chest wall. Physical examination showed a pustule on the sole of his left foot (fi gure A) and multiple pustules on his palms (fi gure B). Blood analysis, chest radiography, and ECG results were normal. Microscopy and culture for bacteria of the pustules was negative, as was serology for Treponema pallidum and HIV. Immunological tests were done, but no abnormalities were found.