Acute Generalized Exanthematic Pustulosis: A Case with a Lymphoma-Like Presentation

Eeckhout, I; Noens, Lucien; Ongenae, Katia; Sarraf, Z. Al; Schelfhout, A.; Jm, Naeyaert

doi:10.1159/000246163

Cited by 16 publications

(9 citation statements)

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“…4 Lymphadenopathy has also been reported. 5 Dysfunction of the internal organs is not expected, although mild acute renal failure occurs in about one-third of patients. Mild hepatic dysfunction and acute renal failure that requires hemodialysis have also been reported.…”

Section: Clinical Findingsmentioning

confidence: 99%

“…Mild hepatic dysfunction and acute renal failure that requires hemodialysis have also been reported. 5 Dysfunction of multiple organ systems is rare, and only a few cases in the literature report hemodynamic disturbances. [6][7][8] We believe that the abnormalities observed on the initial chest scans for our patient were related to cardiogenic pulmonary edema with systemic inflammatory response syndrome-associated increased vascular permeability.…”

Section: Clinical Findingsmentioning

confidence: 99%

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Acute generalized exanthematous pustulosis with severe organ dysfunction

Leclair¹,

Maynard²,

St-Pierre³

2009

Canadian Medical Association Journal

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A 53-year-old man was transferred to our intensive care unit for a generalized exanthem with systemic inflammatory response syndrome. His medical history included a possible disseminated infection of herpes zoster 15 years before the current admission. He had no history of psoriasis, cutaneous drug reaction, immune suppression or heart disease. Before the current incident, he had not been using any prescribed or over-the-counter medications.Seven days before admission, the patient was bitten on his finger by a spider. He reported pain at the site, and there was a necrotic crust. His primary care physician prescribed cefprozil. A few hours after the first dose, a rash developed. The rash was described as a generalized exanthem with nonfollicular superficial pustules and fever. Based on a working diagnosis of recurrent herpes zoster, he was given famciclovir.Two days before admission to our intensive care unit, the patient was admitted to another centre with high fever, fatigue and persistent skin lesions. Because of fever, leukocytosis and pustules, an infectious cause was suspected. Antibiotic coverage was broadened to include piperacillin-tazobactam and moxifloxacin. The results of tests for infectious and immunosupressive diseases were negative. A computerized tomography (CT) scan of the patient's chest showed alveolar opacities with a ground-glass appearance in both upper lungs. A CT scan of the patient's abdomen showed small nonspecific opacities in his liver. The patient was then transferred to our centre.When the patient arrived at our centre, he had a fever (39.9°C) and was tachycardic (130 beats/min) and hypotensive (90/80 mm Hg). His oxygen saturation was 90% on room air. There was no jugular venous distension. The results of a cardiac examination were unremarkable, except for tachycardia. More than 80% of his skin, including his face and scalp, was affected by a generalized erythema with multiple small nonfollicular pustules. An examination of his mucous membranes showed redness of his tongue. He did not have the Nicolsky sign. (The Nikolsky sign is detected by applying pressure to the skin, which causes intraepidermal cleavage that allows the superficial skin to slip free from the deeper layer. It is mainly seen with bullous diseases and toxic epidermal necrolysis.)Important laboratory results are shown in Table 1. An electrocardiogram showed only sinus tachycardia. We suspected a cutaneous drug reaction. The main diagnoses considered at that time were Stevens-Johnson syndrome or toxic epidermal necrolysis and acute generalized exanthematous pustulosis associated with severe systemic inflammatory response syndrome. The results of the CT scan of the patient's chest were suggestive of an acute lung injury. An infectious cause was not likely because all of the cultures were negative. Antibiotics were discontinued, and fluid resuscitation was initiated. A few hours after admission, our patient developed pulmonary edema with acute respiratory failure. Noninvasive positive pressure ventilation and diuretic ...

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Section: Clinical Findingsmentioning

confidence: 99%

Section: Clinical Findingsmentioning

confidence: 99%

Acute generalized exanthematous pustulosis with severe organ dysfunction

Leclair¹,

Maynard²,

St-Pierre³

2009

Canadian Medical Association Journal

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“…Mild eosinophilia, transient renal failure, hypocalcemia, and elevated amino transferase levels may accompany fever and neutrophilic leukocytosis . Lymphadenopathy has described in some cases . Once the causative drugs have been discontinued, spontaneous resolution within 15 days occurs …”

Section: Discussionmentioning

confidence: 99%

“…14 Lymphadenopathy has described in some cases. 15 Once the causative drugs have been discontinued, spontaneous resolution within 15 days occurs. 2 Due to the benign self-limiting course of AGEP, specific treatment usually is unnecessary in mild cases.…”

Section: Discussionmentioning

confidence: 99%

A case of prolonged generalized exanthematous pustulosis caused by hydroxychloroquine—Literature review

Mohaghegh

Jelvan

Rajabi

2018

Clinical Case Reports

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“…Cutaneous reactions are observed less frequently but urticaria, angio-oedema, erythema multiforme, exanthema, pruritus, pustular eruptions, fixed drug eruptions, glossitis, oral ulceration, and vaginitis have been described 6. Henoch-Schönlein purpura with systemic manifestations, including renal involvement7 and acute generalised exanthematic pustulosis8 have recently been reported. Phenytoin,9 carbamazepine,10phenothiazine,11 angiotensin converting enzyme inhibitors,12 β-blockers,13antidepressants,14 and benzodiazepines15 have already been reported to cause atypical cutaneous lymphoid infiltrates, mimicking pseudolymphoma but cephalosporins, to our knowledge, have not been previously linked with this tissue response.…”

Section: Discussionmentioning

confidence: 99%

Cefuroxime induced lymphomatoid hypersensitivity reaction

Saeed

Bazza²,

Zaman³

et al. 2000

Postgraduate Medical Journal

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A symptomatic case of tongue base varices in a patient with portal hypertension secondary to liver cirrhosis is presented. There are no previously documented cases in the world literature. Oesophageal varices may not be the only source of expectorated blood in a patient with portal hypertension. (Postgrad Med J 2000;76:576-577) Keywords: portal hypertension; lingual; tongue; varicose vein Case reportAn 82 year old women with known portal hypertension secondary to cirrhosis of the liver was referred to the otolaryngology outpatient department with a two month history of daily haemoptysis and bloodstained pharyngeal secretions; this occurred mostly on early morning coughing. There was no history of weight loss, dysphagia, dysphonia, or throat pain. She had already been investigated for a pulmonary cause of the haemoptysis and none was found. In keeping with her history, liver function tests and the prothrombin time were abnormal. She also had a history of well controlled essential hypertension. Chest radiography showed cardiomegaly, but the jugular venous pressure was not raised and there was no other clinical manifestation of heart failure.Indirect laryngoscopy revealed varicose vessels in the tongue base, mainly on the left side (see fig 1). These appeared friable and one area revealed a propensity to bleed on examination. The rest of the ear, nose, and throat examination was normal.After perioperative cover with fresh frozen plasma, vitamin K, and tranexamic acid she underwent ablation of the varicosities using a 15 watt continuous carbon dioxide laser under general anaesthesia (see fig 2). She had an uneventful recovery and has remained symptom free. AnatomyThe dorsal lingual veins drain the tongue base through two or more tributaries. These course inferiorly, join together and form the lingual vein, which accompanies the lingual artery. These vessels pass between genioglossus and hyoglossus and the vein empties into the internal jugular vein just above the level of the greater cornu of the hyoid bone. (2) Periumbilical veins-veins contained in the falciform ligament anastomose with superior and inferior epigastric veins of the anterior abdominal wall. Excessive dilatation of these veins are evident as caput medusa.(3) Haemorrhoids-the superior rectal vein anastomoses with the middle rectal vein which drains into the internal iliac vein. In addition the middle rectal veins anastomose with the inferior rectal veins which drain into the internal pudendal vein. Increased shunting results in internal and external haemorrhoids. Thus, there is no recognised anastomosis between lingual venous drainage and the portal circulation. DiscussionA varicosity is a condition indicating an enlarged and tortuous vein. Previously described lingual varices referred to sublingual varices on the ventral surface of the tongue or floor of mouth. These were ascribed to the use of dentures, and vitamin C deficiency in an elderly population. 3Burket associated the occurrence of lingual varices with cardiorespiratory disease,...

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Acute Generalized Exanthematic Pustulosis: A Case with a Lymphoma-Like Presentation

Abstract: A 28-year-old woman developed an acute generalized exanthematic pustulosis in association with a massive lymphadenopathy. A viral etiology seemed highly probable although a drug reaction could not be excluded.

Cited by 16 publications

References 0 publications

Acute generalized exanthematous pustulosis with severe organ dysfunction

Acute generalized exanthematous pustulosis with severe organ dysfunction

A case of prolonged generalized exanthematous pustulosis caused by hydroxychloroquine—Literature review

Cefuroxime induced lymphomatoid hypersensitivity reaction

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