Acute Generalized Exanthematous Pustulosis With Multiple Organ Dysfunction Syndrome

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.

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Acute generalized exanthematous pustulosis (AGEP). Case report

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652005000300011 ◽

2005 ◽

Vol 47 (3) ◽

pp. 171-176 ◽

Cited By ~ 15

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.

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Acute Generalized Exanthematous Pustulosis Induced by Amoxicillin/Clavulanic Acid

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475415588003 ◽

2015 ◽

Vol 19 (6) ◽

pp. 592-594 ◽

Cited By ~ 6

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.

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Rapid Involution of Pustules during Topical Steroid Treatment of Acute Generalized Exanthematous Pustulosis

Case Reports in Dermatology ◽

10.1159/000471842 ◽

2017 ◽

Vol 9 (1) ◽

pp. 135-139 ◽

Cited By ~ 3

Author(s):

Christiane Kley ◽

Carla Murer ◽

Julia-Tatjana Maul ◽

Barbara Meier ◽

Florian Anzengruber ◽

...

Keyword(s):

Topical Steroid ◽

Steroid Treatment ◽

Clobetasol Propionate ◽

Topical Steroids ◽

First Line ◽

Acute Generalized Exanthematous Pustulosis ◽

Cutaneous Adverse Reaction ◽

Amoxicillin Clavulanic Acid ◽

Diffuse Erythema ◽

Exanthematous Pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a dramatic generalized pustular rash of severe onset, which is considered a serious cutaneous adverse reaction to drugs. However, even though the clinical features are impressive and are often accompanied by systemic inflammation, it can be controlled quickly and safely by topical steroids subsequent to interruption of the offending drug. Here, we describe the management of a case and the evolution of the pustular rash. An elderly woman consulted with a generalized crop of 2–3 mm, nonfollicular pustules on erythematous background. In the 4 preceding weeks, she had been using amoxicillin/clavulanic acid for a bacterial implant infection and rivaroxaban. The clinical EuroSCAR criteria including the histology confirmed AGEP. Her medication was stopped and topical clobetasol propionate was used. Within 24 h, the development of new pustules ceased and the patient was discharged after 7 days of hospitalization with only a faint, diffuse erythema and focal desquamation remaining. This and many other cases in the literature suggest that topical steroids should be considered as a first-line treatment option, especially as systemic steroids themselves can sometimes induce generalized pustulosis.

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Drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms with skin eruptions mimicking acute generalized exanthematous pustulosis

The Journal of Dermatology ◽

10.1111/1346-8138.16190 ◽

2021 ◽

Author(s):

Taeko Goto ◽

Asako Kogure ◽

Yoshihiro Kuwano

Keyword(s):

Drug Reaction ◽

Hypersensitivity Syndrome ◽

Drug Induced ◽

Acute Generalized Exanthematous Pustulosis ◽

Systemic Symptoms ◽

Exanthematous Pustulosis

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Drug-Induced Acute Generalized Exanthematous Pustulosis With Positive Patch Test Results

Dermatitis ◽

10.1097/01206501-199612000-00023 ◽

1996 ◽

Vol 7 (4) ◽

pp. 257

Author(s):

Marti Jill Rothe

Keyword(s):

Patch Test ◽

Test Results ◽

Drug Induced ◽

Positive Patch Test ◽

Acute Generalized Exanthematous Pustulosis ◽

Exanthematous Pustulosis

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An extensive unprovoked left lower extremity deep vein thrombosis secondary to an anatomical anomaly: a case of May-Thurner syndrome

Clinics and Practice ◽

10.4081/cp.2017.938 ◽

2017 ◽

Vol 7 (2) ◽

Cited By ~ 3

Author(s):

Irfan Ahsan ◽

Binish G. Qureshi ◽

Ali Raza Ghani ◽

Faizan Malik ◽

Zulfiqar Arif

Keyword(s):

Lower Extremity ◽

Young Patients ◽

Lumbar Vertebra ◽

Rare Condition ◽

Iliac Vein ◽

Young Female ◽

The Body ◽

Common Iliac Vein ◽

Venous Flow ◽

Left Lower Extremity

May-Thurner syndrome (MTS) also known as Cockett’s syndrome is a rare condition responsible for 2%-3% of all cases of deep venous thrombosis (DVT). The thrombosis results from mechanical compression of the left common iliac vein against the body of the fifth lumbar vertebra by the right common iliac artery. Repetitive hyperplasia of the venous wall by compression results in spur formation that in turn causes venous flow obstruction and results in the DVT. Our case is a young female who had acute extensive proximal DVT due to MTS that was successfully managed using mechanical thrombectomy with a venous stent. MTS although a rare entity should be suspected especially in young patients with unilateral DVT with extensive clots especially on left lower extremity without any antecedent risk factors.

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