Oral Prednisolone Induced Acute Generalized Exanthematous Pustulosis due to Corticosteroids of Group A Confirmed by Epicutaneous Testing and Lymphocyte Transformation Tests

Abstract

Background:Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous eruption which is often provoked by drugs. Case Report:We report 2 cases of AGEP which showed rapidly spreading pustular eruptions accompanied by malaise, fever and neutrophilia after the administration of systemic prednisolone (corticosteroid of group A, hydrocortisone type). The histological examination showing neutrophilic subcorneal spongiform pustules was consistent with the diagnosis of AGEP. In both cases the rash cleared within a week upon treatment with topical steroids (corticosteroid of group D1, betamethasonedipropionate type and corticosteroid of group D2, hydrocortisone-17-butyrate type). Three months after recovery, the sensitization to corticosteroids of group A was confirmed by epicutaneous testing and positive lymphocyte transformation tests. Conclusion: These cases show that systemic corticosteroids can induce AGEP and demonstrate that epicutaneous testing and lymphocyte transformation tests may be helpful in identifying the causative drug. Our data support previous reports indicating an important role for drug-specific T cells in inducing neutrophil inflammation in this disease.

Lipomatous Metaplasia after Severe and Chronic Cutaneous Inflammation

“…Following medical examination and positive patch testing of metamizole that has been reported to be a reliable test method [9], metamizole seems to be the most likely drug causative for this severe immune reaction, although it is not among the most frequent causative drugs responsible for an AGEP [10]. However, besides the most common causative drugs like antibiotics [11] or diltiazem [12], a huge variety of drugs including even corticosteroids [13] have been reported to induce AGEP.…”

Acute generalized exanthematous pustulosis

“…Over recent years, numerous publications [15,31,59,60] have reported a high rate of strongly positive patch test reactions with the offending drugs in AGEP patients. In a controlled study [60], patch tests were positive in seven of 14 AGEP cases.…”

The Trouble with HARRIS (Hypersensitivity and Allergic Reactions Related to Iatrogenic Substances)

“…Apparently, it looked like a waste of time, but such an approach has generated the publication of many innovative articles in the field of allergy and dermatology on the last decades, derived from European immunological studies, as the identification of four subgroups of cellmediated hypersensitivity linking the clinical presentation of skin eruptions to specific drug related T cell-subsets and particular cytokine inflammatory patterns proposed by Pichler [5] or the classification of corticosteroid contact hypersensitivity in four groups related to their different stereo chemical structure suggested by Coopman and Goossens [6]. Their classification can be used successfully in drug induced severe cutaneous reactions as acute generalized exanthematous pustulosis due to glucocorticoids [7].…”