scholarly journals Acute generalized exanthematous pustulosis (AGEP). Case report

2005 ◽  
Vol 47 (3) ◽  
pp. 171-176 ◽  
Author(s):  
Walter Belda Junior ◽  
Ana Carolina Junqueira Ferolla
Keyword(s):  
Antidepressant Drugs ◽  
Corticosteroid Treatment ◽  
Beta Lactam ◽  
Drug Induced ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Outpatient Unit ◽  
Similar Drug ◽  
Generalized Pustular Psoriasis ◽  
Inflammatory Drugs ◽  
Exanthematous Pustulosis

Acute Generalized Exanthematous Pustulosis (AGEP) is a drug-induced dermatosis characterized by an acute episode of sterile pustules over erythematous-edematous skin. It is accompanied by an episode of fever, which regresses a few days after discontinuation of the drug that caused the condition or as a result of corticosteroid treatment. The main triggering drugs are antibiotics, mainly beta-lactam ones. Other medications, such as antifungal agents, non steroid anti-inflammatory drugs, analgesics, antiarrhythmic, anticonvulsant and antidepressant drugs, may also be responsible. Histologically, it is characterized by the existence of vasculitis, associated with non-follicular subcorneal pustules. A case of a Caucasian female outpatient unit of Dermatology with AGEP, who presented with generalized pustulosis lesions after the use of cephalosporin for urinary infection is related. The diagnosis was confirmed by the clinical and pathological correlations, the resolution of the dermatosis after discontinuation of the drug and use of systemic corticosteroid treatment, and the recurrence of the disorder after the introduction of a similar drug. The importance of the recognition of this drug-induced dermatosis is given by its main differential clinical and histological diagnoses: generalized pustular psoriasis and subcorneal pustulosis.

scholarly journals Steroid-resistant Acute Generalized Exanthematous Pustulosis Mimicking Generalized Pustular Psoriasis Successfully Treated by Methotrexate

2021 ◽  
Vol 79 (3) ◽  
pp. 257-260
Author(s):  
Khairuddin Djawad
Keyword(s):  
Inflammatory Cell ◽  
Pustular Psoriasis ◽  
Clinical Form ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Steroid Resistant ◽  
Pustular Eruption ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Generalized Pustular Psoriasis ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis is a rare drug-induced eruption that is characterized by sterile non-follicular pustules arising on an often edematous diffuse erythematous background. Generalized pustular psoriasis is an acute and severe clinical form of psoriasis presenting as pustular eruption with erythematous base. Differentiating both diseases is often challenging because of their clinical and histopathological similarities. A 62-year-old woman presented with pustular eruption and fever three days after taking propyphenazone. Laboratory findings revealed leukocytosis and neutrophilia. Histopathological findings revealed a subcorneal spongiform pustule filled with neutrophils and perivascular inflammatory cell infiltration with neutrophils in the dermis. She was initially treated with systemic steroids, however, the lesions showed insignificant improvement. Treatment was then shifted to methotrexate which resulted in a dramatic clinical improvement.

Acute Generalized Exanthematous Pustulosis With Multiple Organ Dysfunction Syndrome

2013 ◽  
Vol 22 (3) ◽  
pp. 270-273 ◽  
Author(s):  
Ghulam Rehman Mohyuddin ◽  
Manar Al Asad ◽  
Lindsay Scratchko ◽  
Ghulam Khaleeq
Keyword(s):  
Lower Extremity ◽  
Rare Condition ◽  
Skin Condition ◽  
Multiple Organ ◽  
Drug Induced ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Left Lower Extremity ◽  
Causative Drug ◽  
Diffuse Erythema ◽  
Exanthematous Pustulosis

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.

Acute Generalized Exanthematous Pustulosis Induced by Amoxicillin/Clavulanic Acid

2015 ◽  
Vol 19 (6) ◽  
pp. 592-594 ◽  
Author(s):  
Ekaterini Syrigou ◽  
Dimitra Grapsa ◽  
Andriani Charpidou ◽  
Konstantinos Syrigos
Keyword(s):  
Clavulanic Acid ◽  
Patch Testing ◽  
Clinical Presentation ◽  
Drug Induced ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Amoxicillin Clavulanic Acid ◽  
Exanthematous Pustulosis ◽  
Histopathologic Features

Drug-induced acute generalized exanthematous pustulosis is a rare pustular skin reaction, most commonly triggered by antibiotics. Although its diagnosis is based primarily on the presence of specific clinical and histopathologic features, additional in vivo (patch testing) or in vitro testing may be required, especially in atypical cases, to more accurately determine the causative agent. The authors report a histologically confirmed case of acute generalized exanthematous pustulosis that was induced by amoxicillin/clavulanic acid, as documented by subsequent patch testing, and presented with generalized painful lymphadenopathy, mimicking an acute infectious process. This is a very rare and diagnostically challenging clinical presentation of acute generalized exanthematous pustulosis, which has been reported, to the best of our knowledge, only once previously.

scholarly journals Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab

2021 ◽  
Vol 8 ◽  
Author(s):  
Liangliang Zhang ◽  
Qiuyun Xu ◽  
Tingting Lin ◽  
Shifan Ruan ◽  
Mengting Lin ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Acute Onset ◽  
Cutaneous Lesions ◽  
Diagnostic Score ◽  
Reactive Protein ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Generalized Pustular Psoriasis ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Related Reaction

Acute generalized exanthematous pustulosis is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base. Most cases of acute generalized exanthematous pustulosis (AGEP) clear quickly with a systemic corticosteroid, but severe or recalcitrant cases may need other systemic therapies. In this case, a man in his 40 s with a history of psoriasis consulted a physician about widespread erythema, pustules, target lesions, and fever after the administration of a quadruple antituberculosis drug. Routine laboratory testing revealed elevated white blood cell count and C-reactive protein. The histopathology showed subcorneal pustules, spongiosis as well as lymphocyte and eosinophils infiltration in the dermis. The patient was diagnosed with definitive AGEP according to the diagnostic score from the EuroSCAR study. Cutaneous lesions especially pustules and erythema multiforme-like lesions on the upper arms and palms are crucial for distinguishing AGEP from Generalized pustular psoriasis. The patient was treated with secukinumab as a result of his failure to respond to topical corticosteroids and constrain of systemic steroids. Remission with secukinumab therapy was safe without increased risks of infections. This case indicates that secukinumab is a potential therapy that can rapidly improve the clinical symptoms of AGEP.

scholarly journals Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

2022 ◽  
Vol 11 (2) ◽  
pp. 397
Author(s):  
Enriqueta Vallejo-Yagüe ◽  
Adrian Martinez-De la Torre ◽  
Omar S. Mohamad ◽  
Shweta Sabu ◽  
Andrea M. Burden
Keyword(s):  
Case Reports ◽  
Fatal Outcome ◽  
Case Series ◽  
Beta Lactam ◽  
Clinical Prognosis ◽  
Systemic Involvement ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Exanthematous Pustulosis ◽  
Time To Onset

Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.

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