Acute Generalized Exanthematous Pustulosis

Abstract

The key clinical features of acute generalized exanthematous pustulosis (AGEP) are the acute occurrence of numerous pinhead-sized nonfollicular sterile pustules on an edematous erythema accompanied by fever and leukocytosis. Histology shows mainly spongiform subcorneal and/or intraepidermal pustules, frequently a marked edema of the papillary dermis, neutrophils, and often eosinophils. AGEP is a reaction pattern mostly caused by drugs, the ones with the highest risk being antibacterial agents like ampicillin/amoxicillin, and quinolones, pristinamycin, anti-infective sulfonamides, the antimycotic drug terbinafine, (hydroxy)chloroquine, and diltiazem. In addition, a large number of other drugs as well as infections have been reported as triggers. AGEP is an acute and sometimes severe reaction. When the causative agent is withdrawn, it usually resolves quickly without specific treatment.

Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy

“…AGEP is a rare adverse drug reaction with an incidence of one to five cases per million per year [3], but it might be underreported. It can occur at any age and seems to be more frequent in women [4].…”

“…The time period from drug ingestion to reaction onset is usually within 48 h, with antibiotics having a median of 24 h [7]. There is an itching or sometimes burning sensation [3,32]. Mucosal involvement, especially orally, is reported in about 20%–25% of patients but mostly in a limited extension and only on one mucosal region [5].…”

“…AGEP usually shows a mild course but high fever or cutaneous superinfection can complicate the process and lead to severe illness and sometimes life-threatening situations, especially in patients of poor general condition. The reported mortality is under 5% [3,4]. Usually there is a spontaneous resolution of skin lesions within two weeks with a very typical collarette-shaped desquamation in the region of previous pustulosis [3,4].…”

Acute Generalized Exanthematous Pustulosis Induced by Paroxetine in an Adolescent Girl

“…AGEP has rarely been described in the paediatric population (1,2). Viral illnesses, vaccinations (e.g.…”

“…anti-pneumococcal vaccine) and drugs (up to 90% of cases) have been implicated in the pathogenesis of AGEP (1,2). Among drugs, the more commonly identified culprit agents are antibiotics (beta-lactatns, macrolides, quinolones, pristinamycin, anti-infective sulphonamides), antimycotics (terbinafine, ketoconazole), calcium channel blockers (diltiazem), analgesics, antipyretics (paracetamol) and antimalarials (1). To date, however, the precise pathophysiological mechanism has not yet been identified and no report of AGEP caused by paroxetine, an antidepressant, has previously appeared in the English littérature.…”