Assuntos
Pustulose Exantematosa Aguda Generalizada/patologia , Antibacterianos/efeitos adversos , Clindamicina/efeitos adversos , Toxidermias/patologia , Ofloxacino/efeitos adversos , Pele/patologia , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Pustulose Exantematosa Aguda Generalizada/imunologia , Pustulose Exantematosa Aguda Generalizada/metabolismo , Idoso , Biomarcadores/análise , Biópsia , Toxidermias/etiologia , Toxidermias/imunologia , Toxidermias/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Testes do Emplastro , Valor Preditivo dos Testes , Pele/química , Pele/efeitos dos fármacos , Pele/imunologiaAssuntos
Acetaminofen/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Antipiréticos/efeitos adversos , Toxidermias/etiologia , Influenza Humana/tratamento farmacológico , Interleucina-8/sangue , Interleucinas/sangue , Pele/efeitos dos fármacos , Pustulose Exantematosa Aguda Generalizada/sangue , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Pustulose Exantematosa Aguda Generalizada/imunologia , Antivirais/uso terapêutico , Biópsia , Toxidermias/sangue , Toxidermias/diagnóstico , Toxidermias/tratamento farmacológico , Toxidermias/imunologia , Ensaio de Imunoadsorção Enzimática , Glucocorticoides/uso terapêutico , Humanos , Masculino , Oseltamivir/uso terapêutico , Prednisolona/uso terapêutico , Pele/imunologia , Pele/patologia , Resultado do Tratamento , Regulação para Cima , Interleucina 22Assuntos
Pustulose Exantematosa Aguda Generalizada/patologia , Pele/patologia , Síndrome de Stevens-Johnson/patologia , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Administração Oral , Adulto , Anticonvulsivantes/efeitos adversos , Biópsia , Esquema de Medicação , Glucocorticoides/administração & dosagem , Humanos , Lamotrigina , Masculino , Valor Preditivo dos Testes , Prednisolona/administração & dosagem , Pele/efeitos dos fármacos , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome de Stevens-Johnson/etiologia , Fatores de Tempo , Resultado do Tratamento , Triazinas/efeitos adversosRESUMO
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.
Assuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Óleos Voláteis/efeitos adversos , Pistacia/efeitos adversos , Extratos Vegetais/efeitos adversos , Antioxidantes/efeitos adversos , Feminino , Humanos , Adulto JovemRESUMO
A 21-year-old man presented with multiple erythematous nonfollicular papules partially confluent to plaques on his breast and lower abdomen that had been present for 1 month. Grouped pustules were present under the right breast. The patient had been taking finasteride over the past 3 months for androgenetic alopecia. His medical history was negative for psoriasis. Our initial differential diagnosis included dyskeratosis follicularis Darier, allergic contact dermatitis, infectious folliculitis, varicella zoster virus infection, fixed drug eruption, and IgA pemphigus. The white blood cell count and differential were within the normal limits. Results of viral cultures and PCR, as well as bacterial and fungal cultures of skin lesions proved negative. A lesional biopsy specimen showed a slight psoriasiform acanthosis in association with spongiosis and infiltration of both the epidermis and dermis by neutrophils and eosinophils, resulting in formation of subcorneal, intraepidermal, and subepidermal pustules. The results of direct immunofluorescence were negative, excluding an IgA pemphigus. The result of a lymphocyte transformation test was positive for finasteride. On the basis of the time relationship between the administration of finasteride and the development of the skin disease in combination with symptoms resolution on cessation of the drug, the histologic findings, and the positive lymphocyte transformation test result, we consider this to be an unusual type of acute generalized exanthematous pustulosis defined as acute localized exanthematous pustulosis caused by finasteride. Within 4 weeks after withdrawal of finasteride, the rash resolved without any specific therapy. Transient discrete residual hyperpigmentation and scaling were present. The patient refused an oral provocation challenge.
Assuntos
Inibidores de 5-alfa Redutase/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Finasterida/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/imunologia , Pustulose Exantematosa Aguda Generalizada/patologia , Adulto , Alopecia/tratamento farmacológico , Humanos , Ativação Linfocitária , Masculino , Linfócitos T/imunologia , Adulto JovemRESUMO
Iatrogenic skin injuries in hospitalized patients range from drug-related complications to those related to procedures. Common drug complications include drug reaction with eosinophilia and systemic symptoms (DRESS), linear immunoglobulin (Ig) A bullous dermatosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and acute generalized exanthematous pustulosis. Contact dermatitis can result from surgical preparations of chlorhexidine and povidone-iodine, medical adhesives, topical postsurgical ointments, most commonly neomycin and bacitracin, and internal prostheses, including coronary stents, pacemakers, and metal joints. Complications arising from procedures include thrombosis caused by placement of peripherally inserted central catheters, pyoderma gangrenosum from sites of dermal trauma, and anetoderma of prematurity from cutaneous monitoring devices in neonates. Calcinosis cutis and decubitus ulcers are also hospital problems.
Assuntos
Hospitalização , Doença Iatrogênica , Dermatopatias/etiologia , Pele/lesões , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Anetodermia/etiologia , Calcinose/induzido quimicamente , Dermatite de Contato/etiologia , Hipersensibilidade a Drogas/etiologia , Humanos , Doenças Labiais/induzido quimicamente , Úlcera por Pressão/etiologia , Pioderma Gangrenoso/induzido quimicamente , Dermatopatias/induzido quimicamente , Dermatopatias Vesiculobolhosas/induzido quimicamente , Síndrome de Stevens-Johnson/etiologiaRESUMO
Acute generalized exanthematous pustulosis is a rare severe pustular cutaneous adverse reaction characterized by a rapid clinical course with typical histological findings. It is accompanied by fever and acute eruption of non-follicular pustules overlying erythrodermic skin. The causative agents are most frequently antibacterial drugs. We present a patient with acute generalized exanthematous pustulosis caused by methylene blue and indigotin dyes.
Assuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Corantes/efeitos adversos , Indóis/efeitos adversos , Azul de Metileno/efeitos adversos , Pele/efeitos dos fármacos , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Pustulose Exantematosa Aguda Generalizada/patologia , Administração Oral , Corticosteroides/uso terapêutico , Idoso , Biópsia , Corantes/administração & dosagem , Humanos , Índigo Carmim , Indóis/administração & dosagem , Testes Intradérmicos , Masculino , Azul de Metileno/administração & dosagem , Pele/patologia , Resultado do TratamentoAssuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Antimetabólitos Antineoplásicos/efeitos adversos , Toxidermias/etiologia , Glutamatos/efeitos adversos , Guanina/análogos & derivados , Pustulose Exantematosa Aguda Generalizada/patologia , Antimetabólitos Antineoplásicos/uso terapêutico , Glutamatos/uso terapêutico , Guanina/efeitos adversos , Guanina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pemetrexede , Pele/patologiaRESUMO
Amicrobial pustulosis of the folds (APF) is a recently described entity characterized by relapsing pustular lesions predominantly involving the cutaneous flexures and scalp. This disease typically occurs in association with systemic lupus erythematosus and a variety of other autoimmune diseases. We here describe an APF-like pustular eruption predominantly affecting the scalp, face and trunk, occurring during long-term infliximab treatment for Crohn's disease. Immunohistochemical staining of skin biopsy specimens for myxovirus resistance protein A, a marker for type 1 interferon-inducible proteins, showed increased staining in the epidermis and dermal mononuclear inflammatory infiltrate. Our observation further extends the spectrum of cutaneous adverse reactions potentially related to anti-tumor necrosis factor-α, the clinical context in which APF can occur as well as its clinical presentations.
Assuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Anticorpos Monoclonais/efeitos adversos , Doença de Crohn/tratamento farmacológico , Fármacos Gastrointestinais/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Pustulose Exantematosa Aguda Generalizada/patologia , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Feminino , Proteínas de Ligação ao GTP/metabolismo , Fármacos Gastrointestinais/uso terapêutico , Humanos , Infliximab , Proteínas de Resistência a Myxovirus , Neutrófilos/patologia , Prednisolona/uso terapêutico , Índice de Gravidade de Doença , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto JovemAssuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Estimulantes do Sistema Nervoso Central/efeitos adversos , Metilfenidato/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Pustulose Exantematosa Aguda Generalizada/patologia , Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Biópsia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Criança , Humanos , Masculino , Metilfenidato/administração & dosagem , Prednisona/uso terapêuticoRESUMO
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.
Assuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Toxidermias/etiologia , Inibidores da Agregação Plaquetária/efeitos adversos , Ticlopidina/análogos & derivados , Idoso de 80 Anos ou mais , Clopidogrel , Diagnóstico Diferencial , Feminino , Humanos , Ticlopidina/efeitos adversosAssuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Infecções por HIV/complicações , Inibidores da Protease de HIV/efeitos adversos , HIV-1 , Hiperplasia do Linfonodo Gigante/complicações , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Humanos , Masculino , Pancitopenia/complicaçõesRESUMO
BACKGROUND: Both acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN) are adverse cutaneous reactions. Despite the fact that these 2 cutaneous reactions differ in presentation, prognosis, pathologic features, and treatment, overlap can exist between them, creating a diagnostic challenge. OBSERVATIONS: We describe a patient who presented with clinical features of both AGEP and TEN, and we summarize overlapping cases of AGEP-TEN that have been reported in the literature. It is essential to be able to differentiate between AGEP and TEN, as these conditions are clinically and morphologically distinct entities. They also differ considerably in their prognosis and treatment. CONCLUSIONS: Because overlap exists, AGEP should be considered in the differential diagnosis of widespread blistering and erosive conditions. A greater understanding of how to differentiate AGEP and TEN can lead to quicker diagnosis as well as more effective case management and treatment.
Assuntos
Pustulose Exantematosa Aguda Generalizada/diagnóstico , Antibacterianos/efeitos adversos , Síndrome de Stevens-Johnson/diagnóstico , Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Pustulose Exantematosa Aguda Generalizada/tratamento farmacológico , Pustulose Exantematosa Aguda Generalizada/patologia , Adulto , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Biópsia , Diagnóstico Diferencial , Humanos , Hidrocortisona/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Ácido Penicilânico/efeitos adversos , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/efeitos adversos , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Prognóstico , Resultado do TratamentoAssuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Toxidermias , Taxoides/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/patologia , Docetaxel , Toxidermias/patologia , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Antineoplásicos/efeitos adversos , Benzenossulfonatos/efeitos adversos , Carcinoma Hepatocelular/tratamento farmacológico , Toxidermias/etiologia , Neoplasias Hepáticas/tratamento farmacológico , Piridinas/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Niacinamida/análogos & derivados , Compostos de Fenilureia , SorafenibeAssuntos
Pustulose Exantematosa Aguda Generalizada/induzido quimicamente , Toxidermias/diagnóstico , Morfina/efeitos adversos , Pele/patologia , Síndrome de Stevens-Johnson/complicações , Doença Aguda , Pustulose Exantematosa Aguda Generalizada/diagnóstico , Idoso , Dor nas Costas/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Entorpecentes/efeitos adversos , Pele/efeitos dos fármacos , Síndrome de Stevens-Johnson/diagnósticoRESUMO
Allopurinol hypersensitivity syndrome(AHS) is a severe form of cutaneous adverse reaction that is associated with significant morbidity and mortality. We report a case of AHS with the cutaneous manifestation of acute generalised exanthematous pustulosis(AGEP). A 47 year old gentleman, with no previous skin disease, presented with a generalized mildly pruritic erythematous rash on the trunk and all 4 limbs, with patches of superficial non-follicular pustules. Our patient fulfilled both criteria for AGEP and AHS.