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A 10-month-old girl presented with erythematous pruritic rash on cheeks, ears and trunk along with swelling of the feet for last 12 hours (Fig. 1a). She had a fever with coryza for two days and received three doses of paracetamol. Rashes were discrete, round, blanchable, and a few were 'target lesions' (Fig. 1b). There was no evidence of mucosal involvement, arthritis or involvement of any other system. Complete blood count, erythrocyte sedimentation rate and C-reactive protein were normal. A diagnosis of urticaria multiforme was made and she was treated with hydroxyzine and ranitidine. The rashes gradually disappeared in next 4 days.Urticaria multiforme, a form of acute annular urticaria, is a benign, self-limiting cutaneous hyper-sensitivity reaction mediated by histamine. It is characterized by the acute and transient onset of blanchable, arcuate, annular, polycyclic, erythematous wheals and facial or acral edema. It usually occurs in children between 4 months and 4 years. Viral illness, immunization and drugs like antibiotics or paracetamol could be the inciting factors. Erythema multiforme, urticarial vasculitis (both having fixed lesions, dusky, purpuric centers often with necrosis and blistering (a) ( b) FIG.1 Erythematous rash on cheeks, ears and trunk.which resolve slowly over weeks with post inflammatory depigmentation; and mucosal erosions); and serum sickness (high grade fever, myalgia, arthralgia, lymphadenopathy and frequent neutropenia in addition to skin and mucosal involvement) are important differential diagnoses. FIG.1 (a) Alopecia cutis congenita of scalp, prominent scalp veins; (b) Oligodactyly and presence of digital nubbins.A 2-month-old girl, born to a non-consanguinously married parents, presented to us with presence of an open wound at birth which healed with scarring and hair loss, along with abnormalities involving toes of both feet. The lesion was an atrophic scar tissue with a rough and heterogeneous appearance. Physical examination revealed localized alopecia with dimensions of 1.8 × 4 cm (Fig. 1a), along with prominent scalp veins. Cutis marmorata was present all over body. Oligodactyly and digital nubbins were present in bilateral feet (Fig. 1b).Based on the classical clinical presentation of aplasia cutis congenita of scalp, cutis marmorata, prominent scalp veins, and limb abnormality, a diagnosis of Adams Oliver syndrome was considered. Histopathology of hairless atrophic patch showed loss of rete ridges, collagen deposition and loss of skin appendages. Hemogram, liver function tests, kidney function tests, serum electrolytes and Chest X-ray were normal.
Acute generalized exanthematous pustulosis (AGEP) is a skin eruption, frequently drug induced and characterized by the acute development of multiple sterile minute pustules on an erythematous base. There is no case of fexofenadine-induced AGEP in literature (PubMed search). A 40-year-old female presented to us with fever and sudden onset development of multiple discrete to coalescent 1–2 mm nonfollicular pustules on an erythematous base present mainly on her trunk and upper extremities for past 2 days. She had a history of use of fexofenadine 180 mg OD for rhinitis for 2 days. Gram's stain showed no organism and pus culture showed no growth. Histopathological examination revealed subcorneal pustules with epidermal spongiosis. Scattered neutrophils and eosinophils were noted in the dermis. During this period, she took fexofenadine 180 mg unknowingly once following which she developed similar episode within 24–48 h. After withdrawal of the drug, the lesions subsided with scaling in 8–10 days. To the best of our knowledge, this is the first reported case of AGEP induced by fexofenadine. Recognition of such a rare entity is important given the frequent usage of fexofenadine for allergic disorders.
No abstract
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