Download Acute Generalized Exanthematous Pustulosis

ISSN : IJCMI
International Journal of
Clinical & Medical Imaging
Volume 1 • Issue 11 • 1000268
November, 2014
http://dx.doi.org/10.4172/2376-0249.1000268
Clinical case blog
Title: Acute Generalized Exanthematous Pustulosis
Alexander KCLeung1* and Benjamin Barankin2
1
2
Clinical Professor of Pediatrics, University of Calgary; Pediatric Consultant, Alberta Children’s Hospital, Canada
Medical Director and Founder, Toronto Dermatology Centre, Canada
An 80-year-old woman presented with fever and a generalized, erythematous pruritic eruption of 3 days duration. Four
days prior to the eruption, she was treated with terbinafine 250 mg po daily for onychomycosis. She denied any recent viral
illness. There was no personal or family history of skin disease. On examination, her temperature was 38.5°C. Dermatological
examination revealed generalized, symmetrical erythematous macules/patches and multiple, scattered small nonfollicular pustules
with surrounding erythema on the trunk and upper extremities. Mucosal surfaces were spared. Nikolsky sign was negative. Her
white blood cell count was 17.6 x 109/L. Gram staining and bacterial culture of the pustule were negative. A punch biopsy taken
from one of the lesions revealed subcorneal and intraepidermal pustules, widespread spongiosis, and neutrophilic perivascular
infiltration.
Acute generalized exanthematous pustulosis (AGEP) is a rare and potentially severe cutaneous adverse reaction most
commonly in response to drug therapy. The main culprit drugs are antibiotics (macrolides, beta-lactam antibiotics, sulphonamides),
calcium-channel blockers (diltiazem), antifungal agents (terbinafine, ketoconazole), antipyretics (paracetamol), and antimalarials
(hydroxychloroquine, chloroquine). AGEP usually occurs within 5 days of starting the offending medication. AGEP is a type
IV hypersensitivity reaction. Drugs specific CD4+ and CD8+ T cells play a crucial role. Viral and bacterial infections and
*Corresponding author: Alexander K.C. Leung, MBBS, FRCPC,
FRCP(UK&Irel), FRCPCH, FAAP, Clinical Professor of Pediatrics,
the University of Calgary, #200, 233 – 16th Avenue NW, Calgary,
Alberta, Canada T2M 0H5; Telefax: (403) 230-3322; E-mail:
[email protected]
Copyright: © 2014 Leung AKC, et al. This is an open-access article
distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
*Corresponding author: Alexander K.C. Leung, MBBS, FRCPC, FRCP(UK&Irel), FRCPCH, FAAP, Clinical Professor of Pediatrics, the
University of Calgary, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada T2M 0H5; Telefax: (403) 230-3322; E-mail: aleung@
ucalgary.ca
• Page 2 of 2 •
hypersensitivity reaction to mercury have also been incriminated.
Clinically, AGEP manifests with an acute onset of widespread bilateral symmetrical edematous erythematous macules/patches
studded with numerous small scattered non-follicular sterile pustules. The eruption is often pruritic or burning and accompanied
by fever and leukocytosis. AGEP can occur at any age. The sex ratio is approximately equal.
The disease is generally self-limited and resolves within 15 days once the offending agent is withdrawn. Treatment is mainly
symptomatic. Mortality occurs mainly in elderly patients with significant comorbidities.
Volume 1 • Issue 11 • IJCMI