ABSTRACT
Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent.
Subject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Cellulitis/drug therapy , Clindamycin/adverse effects , Erythema/chemically induced , Multiple Organ Failure/etiology , Vancomycin/adverse effects , Acute Generalized Exanthematous Pustulosis/complications , Aged , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/administration & dosage , Ceftriaxone/adverse effects , Ceftriaxone/therapeutic use , Cellulitis/complications , Chronic Disease , Clindamycin/administration & dosage , Clindamycin/therapeutic use , Female , Fluid Therapy , Humans , Hypotension/etiology , Lower Extremity/pathology , Lymphedema/complications , Lymphedema/drug therapy , Obesity, Morbid , Vancomycin/administration & dosage , Vancomycin/therapeutic use , Vasoconstrictor Agents/therapeutic useABSTRACT
A 47-year-old man presented to the emergency department with a rapidly progressive, generalized rash and pustulosis shortly after he had started amoxicillin/clavulanic acid for the treatment of a pulmonary infection. Based on the patient's history and the clinical symptoms, the diagnosis of 'acute generalized exanthematous pustulosis' (AGEP) was suspected. This was confirmed by histopathological examination. The skin abnormalities slowly disappeared after terminating antibiotic medication.
Subject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Amoxicillin-Potassium Clavulanate Combination/adverse effects , Anti-Bacterial Agents/adverse effects , Acute Generalized Exanthematous Pustulosis/diagnosis , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Humans , Male , Middle AgedSubject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Analgesics, Non-Narcotic/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Drug Eruptions/etiology , Ibuprofen/adverse effects , Acute Generalized Exanthematous Pustulosis/immunology , Basophils/immunology , Drug Eruptions/immunology , Humans , Male , Middle AgedSubject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Antipsychotic Agents/adverse effects , Dibenzothiazepines/adverse effects , Drug Eruptions , Female , Humans , Intellectual Disability/psychology , Middle Aged , Psychotic Disorders/drug therapy , Psychotic Disorders/psychology , Quetiapine FumarateSubject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Anti-Bacterial Agents/adverse effects , Pristinamycin/adverse effects , Abscess/drug therapy , Acute Generalized Exanthematous Pustulosis/diagnosis , Breast Diseases/drug therapy , Diagnosis, Differential , Female , Humans , Middle AgedABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Drug Hypersensitivity/complications , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/drug therapy , Enoxaparin/administration & dosage , Enoxaparin/adverse effects , Acute Generalized Exanthematous Pustulosis/chemically induced , Family Practice/methods , Anticoagulants/adverse effects , Heparin, Low-Molecular-Weight/administration & dosage , Heparin, Low-Molecular-Weight/adverse effectsSubject(s)
Acute Generalized Exanthematous Pustulosis/pathology , Anti-Bacterial Agents/adverse effects , Clindamycin/adverse effects , Drug Eruptions/pathology , Ofloxacin/adverse effects , Skin/pathology , Acute Generalized Exanthematous Pustulosis/chemically induced , Acute Generalized Exanthematous Pustulosis/immunology , Acute Generalized Exanthematous Pustulosis/metabolism , Aged , Biomarkers/analysis , Biopsy , Drug Eruptions/etiology , Drug Eruptions/immunology , Drug Eruptions/metabolism , Female , Humans , Immunohistochemistry , Patch Tests , Predictive Value of Tests , Skin/chemistry , Skin/drug effects , Skin/immunologySubject(s)
Acetaminophen/adverse effects , Acute Generalized Exanthematous Pustulosis/chemically induced , Antipyretics/adverse effects , Drug Eruptions/etiology , Influenza, Human/drug therapy , Interleukin-8/blood , Interleukins/blood , Skin/drug effects , Acute Generalized Exanthematous Pustulosis/blood , Acute Generalized Exanthematous Pustulosis/drug therapy , Acute Generalized Exanthematous Pustulosis/immunology , Antiviral Agents/therapeutic use , Biopsy , Drug Eruptions/blood , Drug Eruptions/diagnosis , Drug Eruptions/drug therapy , Drug Eruptions/immunology , Enzyme-Linked Immunosorbent Assay , Glucocorticoids/therapeutic use , Humans , Male , Oseltamivir/therapeutic use , Prednisolone/therapeutic use , Skin/immunology , Skin/pathology , Treatment Outcome , Up-Regulation , Interleukin-22ABSTRACT
BACKGROUND: Drug patch tests (PTs) can reproduce delayed hypersensitivity to drugs and entail a moderate re-exposure of patients to offending drugs. OBJECTIVES: To determine the value of PTs for identifying the responsible drug in severe cutaneous adverse drug reactions (SCARs) such as acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). METHODS: In a multicentre study, PTs were conducted on patients referred for DRESS, AGEP or SJS/TEN within 1 year of their SCAR. All drugs administered in the 2 months prior to and the week following the onset of the SCAR were tested. RESULTS: Among the 134 patients included (48 male, 86 female; mean age 51·7 years), positive drug PTs were obtained for 24 different drugs. These included positive tests for 64% (46/72) of patients with DRESS, 58% (26/45) of those with AGEP and 24% (4/17) of those with SJS/TEN, with only one relapse of AGEP. The value of PTs depended on the type of drug and the type of SCAR (e.g. carbamazepine was positive in 11/13 DRESS cases but none of the five SJS/TEN cases). PTs were frequently positive for beta lactams (22 cases), pristinamycin (11 cases) and in DRESS with pump proton inhibitors (five cases), but were usually negative for allopurinol and salazopyrin. Of 18 patients with DRESS, eight had virus reactivation and positive PTs. In DRESS, multiple drug reactivity was frequent (18% of cases), with patients remaining sensitized many years later. CONCLUSIONS: PTs are useful and safe for identifying agents inducing SCAR.
Subject(s)
Drug Eruptions/diagnosis , Acute Generalized Exanthematous Pustulosis/chemically induced , Adolescent , Adult , Aged , Aged, 80 and over , Drug Eruptions/etiology , Drug Interactions , Eosinophilia/chemically induced , Female , Humans , Male , Middle Aged , Patch Tests/adverse effects , Patch Tests/methods , Stevens-Johnson Syndrome/chemically induced , Stevens-Johnson Syndrome/etiology , Time Factors , Young AdultSubject(s)
Acute Generalized Exanthematous Pustulosis/pathology , Skin/pathology , Stevens-Johnson Syndrome/pathology , Acute Generalized Exanthematous Pustulosis/chemically induced , Acute Generalized Exanthematous Pustulosis/drug therapy , Administration, Oral , Adult , Anticonvulsants/adverse effects , Biopsy , Drug Administration Schedule , Glucocorticoids/administration & dosage , Humans , Lamotrigine , Male , Predictive Value of Tests , Prednisolone/administration & dosage , Skin/drug effects , Stevens-Johnson Syndrome/drug therapy , Stevens-Johnson Syndrome/etiology , Time Factors , Treatment Outcome , Triazines/adverse effectsABSTRACT
Acute generalized exanthematous pustulosis (AGEP) is a clinical reaction pattern characterized by the rapid appearance of widespread sterile, nonfollicular pustules arising within edematous erythematous skin. This aseptic pustular eruption is commonly accompanied by leukocytosis and fever and usually follows recent administration of oral or parenteral drugs. We report two cases of terbinafine-induced AGEP in male patients. Both patients developed a generalized erythroderma with scaling and pruritic pustules 7 and 14 days following initiation of oral terbinafine. With immediate discontinuation of terbinafine and various treatment protocols, both patients demonstrated recovery followed by skin desquamation during the subsequent weeks. Terbinafine is the most frequently used systemic antimycotic and antifungal medication, reflecting its superior efficacy for dermatophyte infections. Despite the appealing drug profile, an awareness of terbinafine-induced AGEP is important given the 5 percent mortality associated with AGEP. Additionally, distinguishing the characteristics of AGEP from those associated with toxic epidermal necrolysis, Stevens-Johnson syndrome, and generalized pustular psoriasis allows for prompt dermatologic evaluation, accurate diagnosis, and appropriate treatment.
Subject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Antifungal Agents/adverse effects , Drug Eruptions/etiology , Naphthalenes/adverse effects , Acute Generalized Exanthematous Pustulosis/drug therapy , Administration, Oral , Adult , Antifungal Agents/administration & dosage , Antifungal Agents/therapeutic use , Humans , Male , Naphthalenes/administration & dosage , Naphthalenes/therapeutic use , Onychomycosis/drug therapy , TerbinafineABSTRACT
No disponible
Subject(s)
Humans , Female , Aged, 80 and over , Acute Generalized Exanthematous Pustulosis/chemically induced , Nystatin/adverse effects , Patch TestsABSTRACT
BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is an uncommon adverse cutaneous reaction, most commonly associated with drugs. CASE: A 38-year-old primigravida whose labor had been induced developed erythema over her chest and abdomen. She was transferred to our department after a failed vacuum extraction, and delivered a mature infant by forceps. On day three postpartum she developed a 40.4 degrees C fever. Although ceftriaxone was administered, her fever persisted (>38 degreesC). On day six of the puerperium, diffuse non-follicular pustules appeared over her neck and trunk, and AGEP was suspected. Two days after ceftriaxone was withdrawn, the eruptions started to resolve without any medical intervention. CONCLUSION: Once the diagnosis of AGEP has been made, the antibiotics being administered must be discontinued. If continued treatment is required, pharmacologically distinct antibiotics must be used instead to aid the rapid self-limitation of the disease.
Subject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Acute Generalized Exanthematous Pustulosis/diagnosis , Anti-Bacterial Agents/adverse effects , Ceftriaxone/adverse effects , Postpartum Period , Acute Generalized Exanthematous Pustulosis/pathology , Adult , Female , Fever , Humans , Labor, Induced/methods , PregnancySubject(s)
Acute Generalized Exanthematous Pustulosis/chemically induced , Acute Generalized Exanthematous Pustulosis/diagnosis , Anti-Bacterial Agents/adverse effects , Drug Eruptions/diagnosis , Intensive Care Units , Vancomycin/adverse effects , Amputation, Surgical , Anti-Bacterial Agents/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Humans , Male , Middle Aged , Penicillanic Acid/adverse effects , Penicillanic Acid/analogs & derivatives , Penicillanic Acid/therapeutic use , Piperacillin/adverse effects , Piperacillin/therapeutic use , Piperacillin, Tazobactam Drug Combination , Postoperative Complications/chemically induced , Postoperative Complications/diagnosis , Vancomycin/therapeutic useABSTRACT
Acute generalized exanthematous pustulosis (AGEP) is an uncommon pustular eruption characterized by small nonfollicular pustules on an erythematous background, sometimes associated with fever and neutrophilia. Over 90% of cases are drug-induced; however, it can be caused in rare cases by other agents. We report two cases of AGEP secondary to ingestion of Pistacia lentiscus essential oil, the first two such cases to our knowledge. The cutaneous morphology, disease course and histological findings were consistent with a definite diagnosis of AGEP, based on the criteria of the EuroSCAR study group. These two cases highlight the need to consider herbal extracts as a potential rare cause of AGEP and to ensure the safety of herbal medicines.
