Acute generalized exanthematous pustulosis x Von Zumbusch’s pustular psoriasis: A diagnostic challenge in a psoriatic patient

Sousa, Aline Soares de; Lara, Osório Alves Corrêa de Castro; Papaiordanou, Francine; Marchioro, Gláucia Silva Simioni; Tebcherani, Antônio José

doi:10.1590/abd1806-4841.20153256

Cited by 10 publications

(9 citation statements)

References 5 publications

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“…AGEP due to ceftriaxone has been previously reported during childhood, with confirmation of the offending drug with patch testing performed in one patient . Adult patients with ceftriaxone‐induced AGEP have also been reported in the literature; however, confirmation with patch testing was not performed in these reports either . Drug patch testing in patients with delayed‐type CADR is considered safe, although relapse of AGEP during patch testing has been reported .…”

Section: Discussionmentioning

confidence: 95%

Acute generalized exanthematous pustulosis due to ceftriaxone: Report of a pediatric case with recurrence after positive patch test

Salman

Yücelten

Çakıcı

et al. 2019

Pediatric Dermatology

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Acute generalized exanthematous pustulosis (AGEP) is seen uncommonly in children and sometimes shows atypical clinical features in this population. Patch testing can be used effectively in children for the confirmation of the culprit drug in cases of multiple drug use. Here, we report a rare, pediatric case of ceftriaxone‐induced AGEP confirmed by patch testing with subsequent recurrence of the skin eruption.

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Section: Discussionmentioning

confidence: 95%

Acute generalized exanthematous pustulosis due to ceftriaxone: Report of a pediatric case with recurrence after positive patch test

Salman

Yücelten

Çakıcı

et al. 2019

Pediatric Dermatology

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“…In AGEP, we usually encounter a febrile and ill patient who is referred a few days after consumption of responsible drug and favorably responses to therapy without any relapse in drugfree periods. However, there are many patients with generalized pustular reaction, especially after HCQ use, who present with incomplete clinical and histopathologic criteria of AGEP or PP [1][2][3][4][5][6][7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…PP can occur in persons with prior psoriasis or de novo. Pregnancy, drugs, rapid tapering of steroids, and systemic infections are known as triggers of generalized pustular psoriasis although drugs are not common triggers [1,2].…”

Section: Introductionmentioning

confidence: 99%

Hydroxychloroquine-induced Unusual Generalized Pustular Cutaneous Reaction As a New Clinical Entity: A Case Series

et al. 2020

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Background: Pustular Psoriasis (PP) and Acute Generalized Exanthematous Pustulosis (AGEP) clinically resemble each other. There are many patients with generalized pustular presentations like hydroxychloroquine-induced pustular reaction who do not completely fall within PP or AGEP categories and needed to be more evaluated. So we examined a large series of these reactions to hydroxychloroquine (HCQ) and reviewed the literature in this regard. Materials and Methods: Records of 20 patients admitted to Razi Hospital, Tehran, Iran with acute onset of generalized pustular eruption following hydroxychloroquine therapy were retrieved, and their demographic and clinical features were reviewed. In the meantime, all related articles in PubMed and Google scholar databases were studied as well. Results: All 20 patients were female with an Mean±SD age of 48.35±13.76 years. The Mean±SD between the first dose and skin eruption was 3.62±1.42 weeks. HCQ was prescribed for them, mainly for rheumatologic conditions and joint problems other than psoriasis. Treatment was planned according to the first clinical judgment, pathological findings, and clinical behavior of the disease. Eleven patients were treated as PP and 9 as AGEP. Conclusion: No evident history of psoriasis, drug-related eruption, as well as rapid and complete response to steroids in some patients, favor AGEP diagnosis. However, the long interval of symptoms appearance, prolonged disease course, relapses despite discontinuation of the responsible drug, and no appropriate response to the steroid, favor PP. So, it could be a new entity.

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“…[1][2][3] Kasus pertama kelainan ini dilaporkan di Brazil oleh Campbell dan Furtado yang mendeskripsikan kasus PEGA pada seorang perempuan setelah mengonsumsi ampisilin. 4,5 Roujeau et al 6 menyatakan bahwa PEGA sering ditemukan pada pasien dengan riwayat psoriasis, akan tetapi pernyataan ini diperdebatkan oleh peneliti lainnya. Pada tahun 1980, Beylot et al menyebutkan bahwa pada beberapa kasus PEGA awalnya timbul sebagai psoriasis, yang kemudian diagnosisnya disingkirkan bila tidak terjadi rekurensi dalam 2 tahun pasca gejala.…”

unclassified

“…Pada tahun 1980, Beylot et al menyebutkan bahwa pada beberapa kasus PEGA awalnya timbul sebagai psoriasis, yang kemudian diagnosisnya disingkirkan bila tidak terjadi rekurensi dalam 2 tahun pasca gejala. 4,5…”

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Pustulosis Eksantematosa Generalisata Akut

Pandaleke¹,

Pandaleke²

2017

JBM

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Acute generalized exanthematous pustulosis (AGEP) is a rare skin disorder commonly caused by drugs. Skin lesions can occur within 1-2 days after drug consumption in the form of sterile pustules on erythematous skin base and accompanied by fever. Mortality rate reaches 5%, especially in elderly patients who have significant comorbid factors. Etiopathogenesis is still unclear, presumed to be drugs (beta-lactam and macrolide antibiotics), although it can also be caused by infection and hypersensitivity to mercury. Incidence of AGEP approximately 1-5 million cases per year. It can occur at all ages, and more common in females than in males. The typical clinical features are non-follicular pustules erupting on erythematous skin and fever. In most cases, the skin lesions begin from the face or intertriginous areas and then within a few hours the pustules will spread to the lower trunk and limbs, accompanied by mild burning and minimal itching complaints. Histopathology provides an overview of sub-corneal spongiform and or intraepidermal pustules which are often accompanied by edema of the dermal papilla and perivascular neutrophil infiltration along with exocytosis of eosinophils. The management of AGEP is to stop the suspected drugs, continued with symptomatic therapy. Prognosis PEGA is generally good, unless secondary infection is present.Keywords: AGEP, sterile pustulesAbstrak: Pustulosis eksantematosa generalisata akut (PEGA) merupakan kelainan kulit langka yang umumnya disebabkan oleh obat. Lesi kulit dapat timbul dalam 1-2 hari setelah mengonsumsi obat berupa pustul steril di atas dasar kulit yang eritematosa dan disertai dengan keluhan sistemik berupa demam. Angka kematian akibat PEGA mencapai 5% terutama pada pasien usia lanjut dengan faktor komorbid yang jelas. Etiopatogenesis PEGA belum jelas, diduga obat (antibiotik golongan beta laktam dan makrolid), meskipun juga dapat diakibatkan oleh infeksi dan hipersensitivitas terhadap merkuri. Insiden terjadinya PEGA kurang lebih 1-5 juta kasus pertahun, dapat terjadi pada semua usia, dan lebih banyak ditemukan pada perempuan dibandingkan laki-laki. Gambaran klinis khas PEGA ialah pustul-pustul non-folikular yang timbul diatas kulit yang eritematosa dan disertai demam. Pada kebanyakan kasus keluhan kulit diawali dari area wajah atau lipatan kemudian dalam beberapa jam pustul akan menyebar ke trunkus dan ekstremitas bagian bawah, kadang disertai rasa terbakar ringan dan gatal minimal. Gambaran histopatologik menunjukkan pustul spongiformis subkorneal dan atau pustul intraepidermal disertai dengan edema pada papila dermis dan infiltrasi neutrofil perivaskular bersamaan dengan eksositosis eosinofil. Penatalaksanaan PEGA ialah menghentikan obat yang dicurigai, dilanjutkan dengan terapi simptomatik. Prognosis umumnya baik dan dapat sembuh sendiri, kecuali bila terdapat infeksi sekunder.Kata kunci: PEGA, pustul steril

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Acute generalized exanthematous pustulosis x Von Zumbusch’s pustular psoriasis: A diagnostic challenge in a psoriatic patient

Cited by 10 publications

References 5 publications

Acute generalized exanthematous pustulosis due to ceftriaxone: Report of a pediatric case with recurrence after positive patch test

Acute generalized exanthematous pustulosis due to ceftriaxone: Report of a pediatric case with recurrence after positive patch test

Hydroxychloroquine-induced Unusual Generalized Pustular Cutaneous Reaction As a New Clinical Entity: A Case Series

Pustulosis Eksantematosa Generalisata Akut

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