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.     

Acute generalized exanthematous pustulosis associated with oral terbinafine

A case history of acute generalized exanthematous pustulosis (AGEP) following oral terbinafine is reported. A 64-year-old woman presented with a rapidly spreading micropustular eruption 3 days after completing a 28-day course of oral terbinafine. There was a positive family history of psoriasis but no personal history. The clinical presentation and histopathology were consistent with AGEP. There was nearly complete resolution of the pustular eruption within 3.5 weeks following cessation of oral terbinafine and treatment with topical and systemic corticosteroids. The patient has remained free of any recurrence 18 months later. A summary of drugs known to be associated with AGEP is presented. Prompt recognition of AGEP is stressed in order to avoid confusion with acute generalized pustular psoriasis or a systemic infection. The most important aspect of management is the immediate withdrawal of the suspect drug.     

Acute generalized exanthematous pustulosis: analysis of cases managed in a tertiary hospital in Singapore

Acute generalized exanthematous pustulosis We reviewed eight cases of acute generalized exanthematous pustulosis managed in a tertiary hospital in Singapore. Background Acute generalized exanthematous pustulosis (AGEP) is a pustular reaction characterized by a sudden eruption of widespread nonfollicular sterile pustules associated with systemic symptoms. AGEP is primarily believed to be an adverse reaction to drugs. Outside of Europe, few reports exist on the clinical presentation of AGEP. Methods  A retrospective review of patients who presented with AGEP to a Singapore tertiary hospital was performed. Results Eight patients were diagnosed with AGEP in 2006–2007. All patients presented with a macular, maculopapular eruption prior to the onset of pustules. AGEP was characterized by nonfollicular, pinpoint pustules, which were generalized and accentuated in the flexural areas in seven of the patients. The remaining patient had erythematous patches, and scattered plaques studded with pustules. Other less common features included oral/genital mucositis, blisters and erosions. The mean duration from the cessation of medications to defervescence, resolution of pustules and normalization of leukocytosis was 5, 6, and 7 d, respectively. Despite the resolution of pustules, two patients had protracted clinical courses with evolution to generalized exfoliative dermatitis and Drug rash, eosinophilia, and systemic symptoms (DRESS), respectively. The implicated medications included antibiotics in six patients, morphine and phenytoin in one patient each. Conclusions Acute generalized exanthematous pustulosis is generally described as benign and self‐limiting. However, in certain patients, the clinical course is prolonged and may exhibit features that overlap with other forms of cutaneous adverse drug reactions such as toxic epidermal necrolysis and DRESS.     

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.     

Allopurinol-induced pustular eruption: an unusually mild case

Pustular drug eruptions are uncommon and usually present with an acute illness. A 75-year-old-woman presented with a widespread pruritic pustular erythematous skin rash. She was otherwise well and had been commenced on allopurinol for gout 3 weeks before developing the rash. A skin biopsy was consistent with a pustular drug eruption, with features of acute generalized exanthematous pustulosis (AGEP). Allopurinol was the probable causative agent and withdrawal resulted in resolution of her eruption within 6 weeks. A diagnosis of AGEP was considered; however, this patient did not fulfil the diagnostic criteria.     

Acute Generalized Exanthematous Pustulosis Associated with Tigecycline

Acute generalized exanthematous pustulosis (AGEP) is a severe and rare eruption that develops mostly from factors related to drugs. It is characterized by a fever and a pustular eruption on the erythematous skin with an acute onset and without follicular localization. Etiopathogenesis has not yet been fully explained. Although it is similar to pustular psoriasis, its clinical, historical and histopathological characteristics are different. In this article, we present a case of AGEP associated with tigecycline that developed in a patient followed up in the intensive care unit for three months with an intra-abdominal injury after a trauma and Acinetobacter baumannii infection.     

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 (AGEP), an uncommon condition in children: case report and review of the literature

Acute generalized exanthematous pustulosis (AGEP) is characterized by acute onset of a widespread pustular eruption in association with fever. It is usually seen as a medication reaction. We describe a 17-month-old boy with AGEP secondary to exposure to amoxicillin. This is an uncommon condition in children.     

Innate immune cells express IL-17A/F in acute generalized exanthematous pustulosis and generalized pustular psoriasis

Acute generalized exanthematous pustulosis (AGEP) and generalized pustular psoriasis (GPP) are rare pustular skin disorders with systemic involvement. IL-17A/F is a proinflammatory cytokine involved in various neutrophilic inflammatory disorders. Here we show that IL-17A/F is highly expressed by innate immune cells such as neutrophils and mast cells in both AGEP and GPP.     

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.     

Oral prednisolone induced acute generalized exanthematous pustulosis due to corticosteroids of group A confirmed by epicutaneous testing and lymphocyte transformation tests

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.     

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.     

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.     

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.     

A diagnostic challenge: acute generalized exanthematous pustulosis or pustular psoriasis due to terbinafine

A 72-year-old man developed a generalized erythematous pustular eruption 11 weeks after commencing terbinafine. Clinically and histologically, the appearance was that of acute generalized exanthematous pustulosis (AGEP), and the disease was managed with topical preparations. Initial improvement was marred by relapse of acute pustulosis, now more in keeping with terbinafine-induced pustular psoriasis (PP), which was successfully treated with acitretin. This case highlights the difficulty of differentiating between AGEP and PP.     

Clopidogrel-associated acute generalized exanthematous pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a skin eruption of rapid onset and progression that is characterized by the formation of numerous sterile pustules on an erythematous background. Other features may include fever and leukocytosis, with resolution usually in less than 15 days. We present an 83-year-old woman with an erythematous pustular eruption following placement of a bare metal coronary stent and initiation of anticoagulation with clopidogrel. She was diagnosed with AGEP after a biopsy was performed and other possible causes of a pustular eruption were excluded. Two medications--carvedilol and rosuvastatin--were initially viewed as possible culprits and were temporarily discontinued. However, the patient's rash continued to worsen. Additionally, she had a persistent low-grade fever, leukocytosis, and a slow rise in her creatinine level. Clopidogrel was discontinued and replaced with ticlopidine on day 7 of hospitalization. Within 48 hours her temperature, white blood cell count, and creatinine level began to improve. Her skin subsequently desquamated and she was sent home on day 20. We discuss drug-induced AGEP and a desensitization protocol that has allowed patients to resume use of clopidogrel following a prior cutaneous reaction to this medication.     

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.     

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.