ABSTRACT
Durante la pandemia por COVID-19 se observaron diversas reacciones adversas a fármacos. Esto pudo haber estado relacionado con una mayor susceptibilidad inmunológica de los pacientes con SARS-CoV-2 a presentar este tipo de cuadros, así como también con la exposición a múltiples medicamentos utilizados en su tratamiento. Comunicamos el caso de un paciente con una infección respiratoria grave por COVID-19, que presentó 2 reacciones adversas graves a fármacos en un período corto de tiempo. (AU)
During the COVID-19 pandemic, various adverse drug reactions were observed. This could have been related to a greater immunological susceptibility of patients with SARS-CoV-2 to present this type of symptoms, as well as exposure to multiple drugs used in their treatment. We report the case of a patient with a severe respiratory infection due to COVID-19, who presented 2 serious adverse drug reactions associated with paracetamol in a short period of time. (AU)
Subject(s)
Humans , Male , Adult , Stevens-Johnson Syndrome/diagnosis , Drug-Related Side Effects and Adverse Reactions/diagnosis , Exanthema/diagnosis , Acute Generalized Exanthematous Pustulosis/diagnosis , COVID-19/complications , COVID-19 Drug Treatment/adverse effects , Patient Care Team , gamma-Globulins/administration & dosage , Methylprednisolone/administration & dosage , Incidence , Risk Factors , Stevens-Johnson Syndrome/drug therapy , Treatment Outcome , Cyclosporine/adverse effects , Drug-Related Side Effects and Adverse Reactions/drug therapy , Exanthema/drug therapy , Acute Generalized Exanthematous Pustulosis/drug therapy , Acetaminophen/adverse effectsABSTRACT
Abstract Background: Acute generalized exanthematous pustulosis is a rare disease. Although it is usually related to drug intake, it is occasionally associated with infections, especially in the pediatric age. It is characterized by the sudden onset of sterile non-follicular pustules on an erythematous fundus, fever, and leukocytosis, with frequent and prompt spontaneous resolution. It mainly affects adults and is uncommon in childhood. Complications have been reported in approximately 20% of cases. Case report: We report the case of a 10-year-old female patient with a 5-day history of fever and dermatosis characterized by countless non-follicular pustules, predominantly on the trunk, inguinal folds, and proximal thighs but not involving palms, soles, and mucous membranes. The patient reported an incident of upper respiratory tract infection that occurred 7 days earlier. Histopathological examination confirmed the diagnosis of acute generalized exanthematous pustulosis. Spontaneous resolution occurred within 2 weeks. Conclusions: This disease is one of the severe cutaneous adverse reactions that usually have a self-limited and benign course within a few weeks. We propose that a previous respiratory infection triggered the acute generalized exanthematous pustulosis in this pediatric case. Knowledge of this pathology by the medical professionals, in general, and the pediatricians, in particular, will prevent an aggressive and inappropriate approach and management.
Resumen Introducción: La pustulosis exantemática generalizada aguda es una enfermedad rara. Aunque usualmente se relaciona con el consumo de drogas, ocasionalmente se asocia con infecciones, sobre todo en edad pediátrica. Se caracteriza por el inicio súbito de pústulas no foliculares estériles sobre un fondo eritematoso, fiebre y leucocitosis, con frecuente y pronta resolución espontánea. Afecta principalmente a los adultos, y no es frecuente en la niñez. Se han reportado complicaciones en cerca del 20% de casos. Caso clínico: Se presenta el caso de una paciente de 10 años con fiebre e historia de dermatosis de 5 días de evolución caracterizada por incontables pústulas no foliculares de predominio en tronco, pliegues inguinales y parte proximal de muslos, respetando palmas, plantas y mucosas. Refirió antecedente de infección respiratoria alta 7 días antes. El examen histopatológico confirmó el diagnóstico de pustulosis exantemática generalizada aguda. Presentó resolución espontánea en el transcurso de 2 semanas. Conclusiones: Esta enfermedad es una de las reacciones adversas cutáneas severas, que tiene un curso usualmente autolimitado y benigno en pocas semanas. Proponemos que la pustulosis exantemática generalizada aguda en este caso pediátrico fue desencadenada por la infección respiratoria previa. El conocimiento de esta patología por parte del gremio médico, en general, y del pediatra, en particular, evitará un abordaje y manejo agresivo e inapropiado.
ABSTRACT
Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.
Subject(s)
Female , Humans , Middle Aged , Acute Generalized Exanthematous Pustulosis/microbiology , Mycoplasma pneumoniae , Acute Generalized Exanthematous Pustulosis/pathologyABSTRACT
The occurrence of acute generalized exanthematous pustulosis adverse reactions to medication administration is becoming more frequent. This article reports the case of a 78-year-old woman who attended the clinic with generalized papules and pustules on the scalp, trunk and limbs, with a concordant histology study and who was diagnosed with acute generalized exanthematous pustulosis (AGEP) associated with the use of phenytoin, a medication that may cause different skin reactions and that has been previously related to this disease. The patient was treated with systemic steroids and the disease had a satisfactory outcome.
La aparición de reacciones adversas a medicamentos del tipo pustulosis exantemática generalizada aguda es cada vez más frecuente. Se presenta el caso de una paciente de 78 años quien acude a consulta presentando unas pápulas y pústulas generalizadas en cuero cabelludo, tronco y extremidades, con estudio de histología compatible y a la que se le diagnostica pustulosis exantemática aguda generalizada (PEAG) asociada al uso de fenitoína, una medicación que puede provocar distintas reacciones cutáneas y que previamente se ha asociado a esta enfermedad. La paciente es tratada con esteroides sistémicos y la enfermedad llega a una resolución satisfactoria
Subject(s)
Humans , Acute Generalized Exanthematous Pustulosis , Drug Eruptions , HydantoinsABSTRACT
La pustulosis exantemática generalizada aguda (AGEP, en inglés) es una enfermedad poco frecuente, causada por drogas, caracterizada por aparición aguda de numerosas pústulas estériles en una base eritematosa, asociada en ocasiones a fiebre y leucocitosis, en algunos casos puede causar un compromiso de piel severo pero que resuelve rápidamente con la suspensión del fármaco sin tratamiento especial requerido. Puede confundirse con otras entidades como la psoriasis pustular e inusualmente produce compromiso sistémico. Presentamos un caso de AGEP secundario a terapia anti-TNF con compromiso sistémico.
The acute generalized exanthematous pustulosis (AGEP, in english)is a rare disease caused by drugs, characterized by acute onsetof numerous sterile pustules on an erythematous base, sometimesassociated with fever and leukocytosis, in some cases may causea severe skin involvement reaction but solved quickly with the drugsuspension without special treatment required. It can be confusedwith other entities such as pustular psoriasis and unusually producesystemic involvement. We present a case of secondary to anti-TNFtherapy AGEP systemic involvement.
Subject(s)
Humans , Acute Generalized Exanthematous Pustulosis , Psoriasis , Skin DiseasesABSTRACT
La pustulosis exantemática generalizada aguda (PEGA) es una erupción cutánea severa de escasa frecuencia, caracterizada por la aparición de pústulas estériles no foliculares sobre una base eritemato-edematosa, asociada a fiebre y neutrofilia. La hidroxicloroquina (HCQ), una droga antimalárica ampliamente utilizada en enfermedades dermatológicas, ha sido asociada como una causa poco frecuente de PEGA. Presentamos un paciente de sexo femenino de 20 años de edad, que desarrolló PEGA secundaria a la ingesta de hidroxicloroquina.
Acute generalized exanthematous pustulosis (AGEP) is an uncommon severe skin rash characterized by the appearance of non-follicular sterile pustules on an erythematous background, associated with fever and neutrophilia. It ́s characterized by an acute onset and spontaneous resolution within 2 weeks. Hydroxychloroquine (HCQ), an antimalarial drug widely used in dermatological diseases, has been associated as a rare cause of PEGA. We present a 20 years old woman who developed AGEP secondary to HCQ.
Subject(s)
Humans , Female , Young Adult , Hydroxychloroquine , Acute Generalized Exanthematous Pustulosis/etiology , Adrenal Cortex Hormones , Exanthema , Acute Generalized Exanthematous Pustulosis/diagnosisABSTRACT
La pustulosis exantemática aguda generalizada (PEAG) es una enfermedad poco frecuente, de patogenia desconocida, provocada generalmente por fármacos, entre los que se encuentran en primer lugar, los antibióticos del grupo de los betalactámicos. Se presenta el caso de una paciente con esta entidad, provocada por amoxicilina-clavulánico con gran extensión de las lesiones.
Acute generalized exanthematous pustulosis (AGEP) is a rare disease, with unknown pathogenesis, usually caused by drugs where we can find in the first place, antibiotics that are part of the betalactam group. A case of a patient with this entity, caused by amoxicillin-clavulanic with great extension of the lesions is reported.