Acute generalized exanthematous pustulosis (AGEP). Case report

Abstract

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.

Ipilimumab-induced acute generalized exanthematous pustulosis in a patient with metastatic melanoma

“…It is estimated that ∼ 20% of patients with AGEP manifest mucous membrane involvement [9]. The symptoms and signs of this patient improved after discontinuation of the medication and introduction of corticosteroid therapy, as expected in cases of AGEP, where there is resolution of lesions once the causative drugs are stopped [7,12].…”

“…diltiazem), anticonvulsant and antidepressants [7,8]. Clinically, it is often difficult to distinguish between AGEP and generalized pustular prosiasis or subcorneal pustulosis [7].…”

“…AGEP lesions are known to commonly occur in the intertriginous areas and the face [7,9]. The onset of pustular eruptions was 2 weeks after the initial administration of the drug, and lesions spread after the second infusion.…”

Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein

“…One of the main triggers of PS is the use of oral corticosteroid therapy, while AGEP is associated with macrolides and beta‐lactam‐based agents, and viral infections. Other triggers for AGEP include quinolones, sulfonamides, terbinafine, antimalarials, calcium channel blockers, non‐steroidal anti‐inflammatory drugs, spider bites and infections by parvovirus B19, cytomegalovirus, coxsackie B4, and mycoplasma pneumonia . Discriminating AGEP vs PS can dictate whether or not corticosteroids, cyclosporine and certain antibiotics are used (or avoided) in a patient's clinical management.…”

Phenytoin-induced acute generalized exanthemous pustulosis

“…1 Other spindle cell neoplasms associated with CD34 expression include cases of sclerotic fibromas, nuchal fibromas, solitary fibrous tumors, cellular blue nevi, nerve sheath tumors, stromal cells surrounding trichoepitheliomas, and Kaposi sarcoma [1][2][3][4][5] (Table II).…”