Acute Generalized Exanthematous Pustulosis Due to Clavulanic Acid

Amaral, Luís Branco; Carneiro‐Leão, Leonor; Cernadas, Josefina

doi:10.1016/j.jaip.2019.09.024

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…Te possibility of other drugs inducing AGEP cannot be ruled out, as 26% of patients were taking multiple drugs simultaneously. Clavulanic acid can also induce acute systemic erythematous impetigo [13]. Other drugs have been reported to be associated with AGEP, such as acetylsalicylic acid, ibuprofen, gliclazide, acarbose, and prednisolone [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Treatment, and Prognosis of Amoxicillin-Induced AGEP/ALEP

Lei,

Fan,

et al. 2024

Dermatologic Therapy

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Background. Amoxicillin was associated with acute generalized exanthematous pustulosis (AGEP), and the clinical characteristics were not clear. The purpose of this study was to explore the clinical characteristics of amoxicillin-induced AGEP and to provide a basis for prevention and treatment. Methods. Case reports and case series of amoxicillin-induced AGEP were collected for retrospective analysis by searching the Chinese and English databases from inception to January 31, 2023. Results. A total of 46 patients were included with a median age of 40 years (range 1.4, 87). The onset time of AGEP ranged from 6 hours to 28 days, with a median of 2.5 days. Fever occurred in 32 patients (69.6%), and pruritus occurred in 13 patients (28.3%). Ten patients (21.7%) had mucous membrane involvement and systemic involvement, respectively. Twenty-two patients had elevated neutrophils, with a median of 12850/mm3 (range 7880, 29140). Skin biopsy mainly showed subcorneal pustules (22 cases, 47.8%), spongy pustules (14 cases, 30.4%), and inflammatory cell infiltration (26 cases, 56.5%). Skin lesions disappeared in a median of 10 days (range 2, 42) after discontinuation of amoxicillin and administration of topical steroids (26 cases, 56.5%) as well as systemic corticosteroids (13 cases, 28.3%). Conclusions. AGEP is a rare complication of amoxicillin and is self-limiting. Clinicians should correctly identify AGEP and should avoid represcribing amoxicillin. Clinicians should correctly identify AGEP and avoid represcribing amoxicillin, which can prevent unnecessary treatment measures.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics, Treatment, and Prognosis of Amoxicillin-Induced AGEP/ALEP

Lei,

Fan,

et al. 2024

Dermatologic Therapy

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“…The β-lactams and β-lactamase inhibitors that have been reported in the literature include oxacillin, dicloxacillin, amoxicillin ± clavulanic acid, piperacillin-tazobactam, and faropenem [ 18 – 30 ]. Cephalosporins implicated in AGEP include cefixime, ceftriaxone, cefepime, and cefotaxime [ 31 – 37 ].…”

Section: Pathogenesismentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management

et al. 2023

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Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.

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“…Finally, several case reports described isolated clavulanate delayed hypersensitivity of varied severity from mild skin eruptions 11 to acute generalized exanthematous pustulosis. 11,12 ∇ Adverse drug reactions are subclassified as type A and B reactions. Type B reactions correspond to drug hypersensitivity reactions.…”

mentioning

confidence: 99%

“…Finally, several case reports described isolated clavulanate delayed hypersensitivity of varied severity from mild skin eruptions 11 to acute generalized exanthematous pustulosis. 11,12 There are limited reports of delayed clavulanate hypersensitivity, also confirmed by IFN-γ release enzyme-linked immunospot assay.…”

mentioning

confidence: 99%