ABSTRACT
Acute generalized exanthematous pustulosis (AGEP) is characterized by the rapid occurrence of many sterile, nonfollicular pustules on an edematous erythema accompanied by leucocytosis and fever. It is usually attributed to drugs, including herbal medications such as rhus in Korea. We report two cases of AGEP due to rhus hypersensitivity treated with anti-tumor necrosis factor (TNF)-alpha. The patients developed a generalized erythematous rash and edema, particularly on the face, with high fever and leukocytosis several days after ingesting rhus chicken or contacting rhus extract. Following treatment with a systemic steroid, the skin rash spread to the entire body and pustules arose on an edematous erythema. After stopping the systemic steroid and administering a subcutaneous injection of Etanercept, the pustular rashes, fever, and edema improved within 4 days. These results suggest that anti-TNF-alpha treatment may be effective for rapidly improving AGEP.