Akute generalisierte exanthematische Pustulose bei nachgewiesener Typ-IV-Allergie

Acute generalized exanthematous pustulosis (AGEP) is characterized by an acute disseminated eruption of multiple, non-follicular pustules. In addition, it can be associated with fever, elevated erythrocyte sedimentation rate, and leukocytosis. The pathogenesis of AGEP is still unknown; however, medications appear a likely cause in most cases. We report on 3 patients with AGEP demonstrating characteristic clinical and histologic features after taking amoxicillin, ampicillin, or diltiazem. All patients had positive patch test reactions to the suspected drugs.     

Piperacillin/Tazobactam-Associated Hypersensitivity Syndrome with Overlapping Features of Acute Generalized Exanthematous Pustulosis and Drug-Related Rash with Eosinophilia and Systemic Symptoms Syndrome

Acute generalized exanthematous pustulosis (AGEP) is a rare disorder characterized by acute onset of erythematous and edematous eruptions with sterile pustules, accompanied by fever, and a self-limiting condition thought to be caused by drugs, in particular, antibiotics. Drug-related rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction, characterized by a generalized skin rash associated with hypereosinophilia, lymphocytosis, and internal organ involvement. These reactions differ in causative agents, as well as clinical presentation, prognosis, and treatment. Therefore, appropriate diagnostic measures should be rapidly undertaken. Herein, we described a patient who developed overlapping features of hypersensitivity syndromes, AGEP and DRESS, with the use of piperacillin and the beta-lactamase inhibitor sodium tazobactam. Coexistence of AGEP and DRESS in the same patient is quite rare. To the best of our knowledge, there have been no previous reports on the coexistence of AGEP and DRESS associated with piperacillin/tazobactam.     

Acute generalized exanthematous pustulosis with confirmed type IV allergy. Report of 3 cases

Acute generalized exanthematous pustulosis (AGEP) is characterized by an acute disseminated eruption of multiple, non-follicular pustules. In addition, it can be associated with fever, elevated erythrocyte sedimentation rate, and leukocytosis. The pathogenesis of AGEP is still unknown; however, medications appear a likely cause in most cases. We report on 3 patients with AGEP demonstrating characteristic clinical and histologic features after taking amoxicillin, ampicillin, or diltiazem. All patients had positive patch test reactions to the suspected drugs.     

Diltiazem-induced acute generalised exanthematous pustulosis

Pustulation is a major feature in several different dermatoses, and it may also occur as a manifestation of drug: hypersensitivity. Acute generalized exanthematous pustulosis (AGEP) is an uncommon eruption characterized by acute, extensive formation of sterile pustules, fever and peripheral blood leucucytosis. It shares several clinical and historical features in common with pustular psoriasis. Most reported cases have been triggered by ingestion of broad spectrum antibiotics, particularly betalactams and macrolides. There is usually rapid resolution of the eruption on drug withdrawal. We report the case of a 58 year-old woman who developed AGEP shortly after commencing treatment with the calcium channel binder diltiazem hydro-chloride. The eruption followed a biphasic course, and improved following treatment with systemic corti-costeroids and methotrexate. AGEP appears to be a rare adverse cutaneous reaction to diltiazem, whereas a wide range of other skin eruptions have been reported more commonly with this drug.     

Acute generalized exanthematous pustulosis due to clindamycin

Acute generalized exanthematous pustulosis (AGEP) is a rare skin eruption most commonly caused by medications. It is characterized by fever and the acute eruption of non-follicular pustules overlying erythrodermic skin. Histopathology shows subcorneal pustules with a background of dermal edema and spongiosis, leukocytoclastic vasculitis, perivascular eosinophils, and focal necrosis of keratinocytes. Three cases of clindamycin induced AGEP have been reported in the literature. A case of AGEP due to clindamycin is reported in a patient with numerous other drug allergies and without history of psoriasis. Presentation and treatment of AGEP are reviewed.     

Acute generalized exanthematous pustulosis induced by the essential oil of Pistacia lentiscus

Acute generalized exanthematous pustulosis (AGEP) is an uncommon pustular eruption characterized by small nonfollicular pustules on an erythematous background, sometimes associated with fever and neutrophilia. Over 90% of cases are drug-induced; however, it can be caused in rare cases by other agents. We report two cases of AGEP secondary to ingestion of Pistacia lentiscus essential oil, the first two such cases to our knowledge. The cutaneous morphology, disease course and histological findings were consistent with a definite diagnosis of AGEP, based on the criteria of the EuroSCAR study group. These two cases highlight the need to consider herbal extracts as a potential rare cause of AGEP and to ensure the safety of herbal medicines.     

Acute generalized exanthematous pustulosis induced by itraconazole: an immunological approach

Acute generalized exanthematous pustulosis (AGEP) is an uncommon disease, which presents as a nonfollicular erythematous sterile pustular eruption. More than 90% of the cases are induced by adverse drug reactions, often triggered by anti-infectious systemic drugs. We report a case of itraconazole-induced AGEP in a 22-year-old man, with an assessment of his cytokine/chemokine production and drug-specific cell reactivity. We found that AGEP, like other T cell-mediated drug eruptions, alters the immunological status of the patient, probably favouring T-cell activation, recruitment and regulation. Few cases of itraconazole-induced AGEP have been described in the literature, and to our knowledge, this is the first report in which the cellular immunological features are assessed.     

Acute generalized exanthematous pustulosis: atypical presentations and outcomes

Acute generalized exanthematous pustulosis (AGEP) is an acute drug eruption characterized by erythematous plaques and papules studded with numerous, pinpoint pustules. Several atypical clinical presentations and triggers of AGEP have been described in the literature. These include systemic presentations similar to toxic epidermal necrolysis (TEN) and drug‐induced hypersensitivity syndrome (DIHS) and localized presentations mimicking other medication reactions. We herein aim to review atypical presentations and medication triggers of AGEP to assist clinicians in recognizing this condition and making appropriate therapeutic interventions.     

A Case of Hydroxychloroquine Induced Acute Generalized Exanthematous Pustulosis Confirmed by Accidental Oral Provocation

Acute generalized exanthematous pustulosis (AGEP) is a clinical reaction pattern that is principally drug induced and this is characterized by acute, nonfollicular sterile pustules on a background of edematous erythema. Hydroxychloroquine (HCQ) has been widely used to treat rheumatic and dermatologic diseases and HCQ has been reported to be an uncommon cause of AGEP. A 38-year-old woman with a 1-year history of dermatomyositis and polyarthralgia was treated with HCQ due to a lack of response to a previous medication. Three weeks after starting HCQ therapy, the pustular skin lesion developed and then this resolved after the HCQ was withdrawn and steroid treatment was started. A similar pustular eruption developed after HCQ was accidentally readministered.     

Acute generalized exanthematous pustulosis complicated by cutaneous small vessel vasculitis: A case report and literature review

Acute generalized exanthematous pustulosis (AGEP) is a rare skin eruption characterized by widespread erythematous lesions covered with numerous pustules. Leukocytoclastic vasculitis is now considered an uncommon but possible histopathological feature within the clinical and pathological spectrum of AGEP. Our report describes a rare case of AGEP overlapping with cutaneous small vessel vasculitis, a condition that has only been reported once in the literature.     

Acute generalized exanthematous pustulosis induced by oral fluconazole

BACKGROUND: Acute generalized exanthematous pustulosis (AGEP) is a generalized, nonfollicular, pustular eruption of the skin associated with fever and leukocytosis. The cause of AGEP has mainly been attributed to drugs. OBJECTIVE: We report a unique case of AGEP in a 75-year-old male caused by oral fluconazole. We include clinical as well as histological illustrations of our case. CONCLUSION: Based on a current literature search using the MEDLINE electronic database, this is the first reported case of AGEP arising from use of oral fluconazole. The clinical presentation, clinical course, and histology are consistent with prior reports of AGEP resulting from other drugs. AGEP should be considered a possible complication of oral fluconazole treatment.     

Acute generalized exanthematous pustulosis with erythema multiforme-like lesions

Acute generalized exanthematous pustulosis (AGEP) resembles generalized pustular psoriasis, but may manifest targetoid lesions, purpura, and blisters in addition to pustules. We describe a case of AGEP with erythema multiforme (EM)-like features in a 35-year-old woman who presented with acute onset of high fever and a strikingly polymorphic eruption consisting of numerous tiny pustules on erythematous bases, marked facial edema, oral and genital erosions, targetoid vesicular and purpuric lesions, pustules in string-of-pearl configuration and ring-like vesicles. The histology revealed, in addition to subcorneal pustules, vacuolar interface dermatitis with involvement of eccrine glands, and microabscesses in pilosebaceous structures. Systemic corticorsteroid and antibiotics were initiated, resulting in rapid resolution without recurrence. Recognition of EM-like lesions on a background of generalized pustular eruption could facilitate the diagnosis of AGEP and the institution of appropriate treatment.     

Pustulosis exantemática aguda generalizada: variante eosinofílica

—Acute generalizaded exanthematous pustulosis (AGEP) is considered a new form of adverse drug eruption. We report a case of this condition in which the pustules were formed almost completly by eosiniphils instead of neutrophils.     

Acute generalized exanthematous pustulosis due to thallium

Acute generalized exanthematous pustulosis (AGEP) is characterized clinically by fever, pruritus and acute pustular eruption. Usually a drug is found to be the responsible agent. We present a patient who experienced an acute generalized exanthematous pustulosis due to radioactive thallium. The eruption cleared rapidly after discontinuation of the drug and systemic corticosteroid therapy.     

A case of acute generalized exanthematous pustulosis (AGEP) possibly induced by iohexol

Acute generalized exanthematous pustulosis (AGEP) is an uncommon disease manifested as an erythematous pustular eruption. It is usually caused by systemic medication. We describe a patient with acute generalized pustular eruption induced by iohexol. A 52-year-old woman developed fever and a generalized pustular eruption on the neck, trunk and extremities three days after taking iohexol. The culture from pustules was sterile. Other systemic and laboratory examinations were normal. A skin biopsy from a lesion on the trunk showed the features of a drug-induced pustular eruption as a subcorneal blister including neutrophils and eosinophils, mild spongiosis, and a sparse infiltrate at neutrophils and eosinophils in the papillary dermis. The patient had no history of psoriasis. The lesions resolved with systemic corticosteroid therapy within one week and did not relapse. According to our investigation, iohexol-induced AGEP has not been previously reported. We present an interesting case.     

表现为中毒性表皮坏死松解症的急性泛发性发疹性脓疱病

报告1例表现为中毒性表皮坏死松解症的急性泛发性发疹性脓疱病。患者男，36岁。因上呼吸道感染口服对乙酰氨基酚及静脉滴注头孢拉定，5d后全身起红斑，脓疱，多数脓疱融合成脓潮，表皮大片脱落，呈中毒性表皮不死松解症表现，组织病理检查符合急性泛发性发疹性脓疱病诊断，予以糖皮质激素及万古霉素等治疗后皮损痊愈。     

Acute generalized exanthematous pustulosis in a six-year-old boy

Acute generalized exanthematous pustulosis (AGEP) presents with an abrupt onset of widespread pustules on erythematous base and rapid spontaneous healing. AGEP may have a variety of causative factors such as drugs, viral infection and exposure to mercury. We report a case of AGEP in a 6-year-old boy who presented with acute onset of fever and widespread pustular eruption on erythematous bases. Histologic examination showed neutrophilic subcorneal spongiform pustule. It is an uncommon condition in children.     

Do the Physical and Histologic Features and Time Course in Acute Generalized Exanthematous Pustulosis Reflect a Pattern of Cytokine Dysregulation?

Background: Acute generalized exanthematous pustulosis (AGEP) is characterized by fever and an indurated erythematous eruption early, with the development of nonfollicular pinhead sterile pustules on an erythematous background. The eruption progresses and resolves relatively rapidly. Although drugs are believed to be the major etiologic agents, other immune modulators, including infections, heavy metals, and radiation, have been implicated. Objective: The purpose of this study was to document underlying diseases in patients with AGEP and to determine if this data and the histologic features suggested an underlying pattern of immune dysregulation. Methods: Twenty-one patients with new or recurrent episodes of AGEP were questioned concerning underlying diseases. The histopathologic features seen in the biopsy sections and the approximate time of biopsy during the course of their eruptions were recorded. Results: Two patients had a history of psoriasis and one patient had a family history of psoriasis, two patients had diagnoses of sarcoid, two patients had inflammatory bowel disease, one had autoimmune thyroiditis, and one patient had multiple sclerosis. Biopsies done at the onset of the eruption showed marked to moderate papillary dermal edema and a mixed dermal inflammatory infiltrate. Shortly thereafter, biopsies showed spongiform pustules within the epidermis and occasional dyskeratotic cells with residual perivascular dermal edema. Although no definitive vasculitis was seen, there was leukocytoclasis within the dermal infiltrate in the majority of biopsy specimens performed more than 48 hours after the onset of the eruption. Conclusion: The histologic features seen in AGEP and the disease associations suggest that patients who develop this eruption may have an underlying tendency for development of a pattern of immune dysregulation characterized by a T helper-1 cytokine pattern.     

Acute Generalized Exanthematous Pustulosisafter Ingestion of Lacquer Chicken

Acute generalized exanthematous pustulosis (AGEP) is an acute pustular eruption characterized by multiple small, sterile, non-follicular pustules on an erythematous and edematous base, usually accompanied by fever and neutrophilia. It is attributed to systemic drugs in over 90% of cases, mainly β-lactam and macrolide antimicrobials. Viral infections, mercury exposure, Ginkgo biloba, and spider bites may occasionally cause the condition. We report a rare case of AGEP induced by intake of lacquer chicken in a 40-year-old man.     

Childhood acute generalized exanthematous pustulosis induced by oral ketoconazole

Acute generalized exanthematous pustulosis is a rare disorder characterized by an acute onset of generalized, nonfollicular, pustular eruption associated with fever. It is usually drug-induced and is uncommon in children. We report a 12-year-old girl with acute generalized exanthematous pustulosis induced by oral ketoconazole. To our knowledge, in spite of its relatively frequent use, acute generalized exanthematous pustulosis due to ketoconazole has not been previously reported.