Acute generalized exanthematous pustulosis caused by a probable spider bite: A case report and review of the literature

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare drug eruption presenting with an acute, extensive formation of nonfollicular sterile pustules on an erythematous and edematous base. Typically, the rash is accompanied by fever and leukocytosis, with spontaneous resolution in < 15 days. The incidence of AGEP is estimated at one to five cases per million people per year. Only 18% of these are from nonantibiotics. Hydroxychloroquine (HCQ) is an antimalarial agent that is also used to treat various dermatologic and rheumatologic conditions. Objective: We report the first observation in Canada of a patient with AGEP induced by HCQ. Methods and Results: AGEP was diagnosed in a 48-year-old female who had been taking HCQ for 2 weeks and then developed a diffuse erythematous and edematous pustular eruption. Clinical and pathologic findings were consistent with a diagnosis of AGEP. The patient was treated with steroids and supportive measures. The rash resolved after 18 days and a complicated course in hospital. Conclusion: AGEP is a rare drug eruption, usually to antibiotics. We report the first case in Canada of AGEP as an adverse reaction to HCQ. Clinicians should keep in mind the possibility of this severe skin eruption.

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Hydroxychloroquine‐induced acute generalized exanthematous pustulosis: a series of seven patients and review of the literature

International Journal of Dermatology ◽

10.1111/ijd.15419 ◽

2021 ◽

Author(s):

Rim Chaabouni ◽

Emna Bahloul ◽

Mariam Ennouri ◽

Rim Atheymen ◽

Khadija Sellami ◽

...

Keyword(s):

Review Of The Literature ◽

Acute Generalized Exanthematous Pustulosis ◽

Exanthematous Pustulosis

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First presentation of Sneddon-Wilkinson disease with unexpected immunoglobulin A gammopathy: A case report and review of the literature

SAGE Open Medical Case Reports ◽

10.1177/2050313x19826432 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1982643

Author(s):

Julia N Mayba ◽

C Nicole Hawkins

Keyword(s):

Clinical Presentation ◽

Hematologic Malignancy ◽

Topical Therapy ◽

Immunoglobulin A ◽

Lymphoproliferative Disorders ◽

Review Of The Literature ◽

First Line ◽

Acute Generalized Exanthematous Pustulosis ◽

Exanthematous Pustulosis ◽

First Line Treatment

We present a case of Sneddon-Wilkinson disease in a 52-year-old female at her first presentation to dermatology. Outlined in the case are various investigations undertaken at this initial presentation, including rheumatologic and hematologic malignancy markers, which identified immunoglobulin A gammopathy. The systemic and topical therapies used to treat the patient’s condition are described, as well as her response to these treatments. In this discussion, we explain the epidemiology, pathophysiology, and clinical presentation of Sneddon-Wilkinson disease. Various medical conditions having known association with Sneddon-Wilkinson disease are discussed, including immunoglobulin A or immunoglobulin G monoclonal gammopathies and lymphoproliferative disorders. A comprehensive differential diagnosis for Sneddon-Wilkinson disease is provided, including immunoglobulin A pemphigus, acute generalized exanthematous pustulosis and pustular psoriasis, among others. We describe the systemic and topical therapy options for the treatment of Sneddon-Wilkinson disease, of which first line treatment is systemic dapsone. This patient serves as an excellent case of Sneddon-Wilkinson disease with unexpected immunoglobulin A gammopathy.

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