An Atypical Presentation of Acute Generalized Exanthematous Pustulosis Induced by Use of Meropenem: A Case Report and Literature Review.

Acute generalized exanthematous pustulosis (AGEP) is a rare dermatological disorder characterized by the development of sterile pustular lesions on erythematous and edematous skin, followed by desquamation of the affected regions. The majority of cases occur following the administration of antimicrobials and antihypertensives. Our case report illustrates the atypical presentation of AGEP in an elderly female following treatment with meropenem for an infected pressure ulcer. Only a limited number of meropenem-associated AGEP have been documented. Our patient's presentation also highlights the difficulty of diagnosing AGEP and its similarity to other rare, drug-associated rashes. By illustrating this atypical clinical presentation of AGEP and highlighting its association with meropenem, we hope to provide insight to clinicians dealing with similar presentations.

Acute generalized exanthematous pustulosis induced by icotinib: a case report and literature review.

Acute generalized exanthematous pustulosis, an infrequent adverse drug reaction, mainly results from drugs. Clinically, acute generalized exanthematous pustulosis manifests as a high fever, with skin lesions of small monomorphic subcorneal sterile pustules on an erythematous that presents at 1-4 days after medication exposure. The incidence of acute generalized exanthematous pustulosis varies from 3/1, 000, 000 to 5/1, 000, 000, while the mortality rate is typically around 5%. We present a case of a 69-year-old female who developed a diffuse, erythematous, pustular rash over the entire body and exhibited a fever of 38.3°C after 4 days of icotinib therapy. Considering her medication history and the appearance of the lesions, she was diagnosed with acute generalized exanthematous pustulosis and received appropriate treatment. We also conducted a literature review through PubMed to compare similarities and differences between our case and those reported in the literature.

Clinical characteristics, treatment and outcome of clindamycin induced acute generalized exanthematous pustulosis.

Acute generalized exanthematous pustulosis (AGEP) is a serious and rare adverse reaction to clindamycin. This study investigated the clinical features of clindamycin-induced AGEP and provided reference for the prevention and treatment of AGEP. Case reports, case series and clinical studies of clindamycin-induced AGEP were collected by retrieving English and Chinese database from inception until May 31, 2024. Of the 35 patients included, 25 (71.4%) were female, and the median age was 57 years (1.6-88 years). The duration of AGEP onset is 2 days (range 0.04,13) after initial administration. The main clinical morphology of AGEP is a non-follicular pustular on an erythematous base, which may be accompanied by fever (54.3%) and pruritus (40.0%). These lesions mainly involved extremities and trunk. The median elevated neutrophil count was 13.3 × 109/L (range 10.3, 31.4). Histologic features of AGEP are characterized by intracorneal, subcorneal, and/or intraepidermal pustules with papillary dermal edema containing neutrophilic, lymphocytic, andeosinophilic infiltrates. Patients gradually recovered after the withdrawal of clindamycin and supportive therapy with a median time of 9 days (range 2, 30). Clinicians should be aware of AGEP as a rare adverse effect of clindamycin. When clindamycin is prescribed, it should be stopped in time when AGEP occurs, and active systemic treatment should be given. AGEP is a self-limiting disease with a good prognosis.

The Australasian Registry for Severe Cutaneous Adverse Reactions (AUS-SCAR) - Providing a roadmap for closing the diagnostic, patient, and healthcare gaps for a group of rare drug eruptions.

Background: Severe cutaneous adverse reactions (SCAR) are a group of delayed presumed T-cell mediated hypersensitivities associated with significant morbidity and mortality. Despite their shared global healthcare burden and impact, the clinical phenotypes, genomic predisposition, drug causality, and treatment outcomes may vary. We describe the establishment and results from the first Australasian registry for SCAR (AUS-SCAR), that via a collaborative network advances strategies for the prevention, diagnosis and treatment of SCAR. Methods: Prospective multi-center registry of SCAR in Australian adult and adolescents, with planned regional expansion. The registry collects externally verified phenotypic data drug causality, therapeutics and long-term patient outcomes. In addition, biorepository specimens and DNA are collected at participating sites. Results: we report on the first 100 patients enrolled in the AUS-SCAR database. DRESS (50%) is the most predominant phenotype followed by SJS/TEN (39%) and AGEP (10%), with median age of 52 years old (IQR 37.5, 66) with 1:1 male-to-female ratio. The median latency for all implicated drugs is highly variable but similar for DRESS (median 15 days IQR 5,25) and SJS/TEN (median 21 days, IQR 7,27), while lowest for AGEP (median 2.5 days, IQR 1,8). Antibiotics (54.5%) are more commonly listed as primary implicated drug compare with non-antibiotics agent (45.5%). Mortality rate at 90 days was highest in SJS/TEN at 23.1%, followed by DRESS (4%) and AGEP (0%). Conclusion: In the first prospective national phenotypic and biorepository of SCAR in the southern hemisphere we demonstrate notable differences to other reported registries; including DRESS-predominant phenotype, varied antibiotic causality and low overall mortality rate. This study also highlights the lack of standardised preventative pharmacogenomic measures and in vitro/in vivo diagnostic strategies to ascertain drug causality. Trial registration: ANZCTR ACTRN12619000241134. Registered 19 February 2019.

Concurrent Presentation of Eczema Herpeticum and Acute Localized Exanthematous Pustulosis in a Patient With Atopic Dermatitis: A Rare Dermatological Convergence.

Eczema herpeticum (EH) is a severe and potentially life-threatening viral infection occurring in individuals with preexisting eczema or atopic dermatitis. It is primarily caused by the herpes simplex virus, presenting as painful vesicular eruptions on the skin. On the other hand, acute localized exanthematous pustulosis (ALEP) is a rare variant of acute generalized exanthematous pustulosis (AGEP), characterized by the sudden onset of localized, nonfollicular pustules on an erythematous base. It is often triggered by recent medication administration, and its clinical presentation mimics AGEP, although ALEP exhibits a confined distribution of pustules. Prompt diagnosis and identification of the offending agent are crucial for effective management. Both are distinct cutaneous manifestations that rarely occur concurrently, presenting unique diagnostic and therapeutic challenges.  We present the first documented case of coexisting ALEP and EH in a 32-year-old male with a history of atopic dermatitis. The patient was admitted with features suggestive of EH, including vesicular lesions over the face, along with a positive Methicillin-resistant Staphylococcus aureus (MRSA) swab. Treatment with ceftaroline initially initiated resulted in the development of localized pustules, indicative of ALEP. Transition to linezolid led to the complete resolution of both conditions, marking a compelling recovery. The distinctive interplay between EH, ALEP, and AGEP presents a novel challenge, emphasizing the need for nuanced clinical assessment and tailored therapeutic strategies. This case offers crucial insights into the intricate relationship between medication-induced dermatological conditions and underlying cutaneous vulnerabilities. This unprecedented case highlights the rarity and complex management nuances associated with the simultaneous occurrence of ALEP and EH. The successful resolution following medication adjustments underscores the need for flexibility and comprehensive evaluation in addressing such intricate dermatological scenarios, providing valuable insights into potential synergies between distinct cutaneous conditions.

Acute generalized exanthematous pustulosis secondary to dose-related turmeric supplementation.

We present the case of a 55-year-old woman with a 10-day history of a rapidly progressing generalized rash. History was significant for recent increase in turmeric supplement dose. Clinical presentation was notable for diffuse plate-like yellow scaling of the scalp with lesser involvement of the ears. On the trunk and extremities, erythematous circinate plaques studded with pustules were noted with central trailing scale and desquamation. Laboratory results showed slight elevation of white blood cell count from her baseline but within normal range. Histopathological analysis of two punch biopsies showed spongiotic dermatitis with eosinophils, and subcorneal pustules with eosinophils, respectively, without any organisms. These findings were most consistent with acute generalized exanthematous pustulosis (AGEP). Treatment included oral and topical corticosteroids as well as discontinuation of all dietary supplements. AGEP, a severe cutaneous adverse reaction, is associated most often with antibiotics; however, many other medications, including herbal supplements, have been documented as triggers in the literature. This is only the second reported case of potential turmeric-induced AGEP and the first reported case establishing a dose-related association between turmeric and AGEP. It is important to consider herbal supplements as part of the medical history to guide proper management when assessing a patient with AGEP.

An unusual adverse effect during crusted scabies treatment.

Crusted scabies is a severe form of scabies infestation caused by the ectoparasite Sarcoptes scabiei. Risk factors include immunosuppression, neuropathies, and psychiatric disorders. Its management poses important challenges due to its contagius nature. Here we present a case or Acute Generalized Exanthematous Pustulosis secondary to Ivermectin therapy in a patient with crusted scabies.