Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso

Abstract

Acute generalized exanthematous pustulosis associated with Mycoplasma pneumoniae infection: a case report Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.

Acute generalized exanthematous pustulosis

“…It has been suggested that viral infections could be the most frequent trigger in the pediatric population 2 . The latency between drug exposure and the onset of AGEP varies from a few hours to 1 to 2 weeks, classically ranging from 48 to 72 hours; in the case of antimicrobials, it is usually less than 24 hours 1,16 .…”

“…Other drugs involved include aminoglycosides, sulfonamides, quinolones, antifungals, antimalarials, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), antihypertensives, calcium channel blockers, and antiepileptics 11,13,14 . The remaining 10% of the cases of AGEP have been associated with viral (enterovirus, adenovirus, parvovirus B19, cytomegalovirus, hepatitis B, Epstein Barr, among others), bacterial (Chlamydia pneumoniae, Escherichia coli, Mycoplasma pneumoniae, among others), and mycotic (pustulosis caused by fungi) infections, spider bites, mercury poisoning 15,16 , parasites, and food drug-specific CD4+ T cells and keratinocytes, which release large amounts of a potent neutrophil cytokine (CXCL8). CXCL8 transforms vesicles into sterile pustules by neutrophil chemotaxis 1,17 .…”

“…In cases of AGEP of infectious etiology, there is no precise pathophysiological mechanism. However, it is hypothesized that infectious antigens could cross-react with drug antigens, act as haptens, or synergistically with some drugs, triggering the same immunologic reaction as in classical drug-induced AGEP 16 . Regarding the underlying pathogenesis, it has been proposed that drug-like infections lead to T-cell activation 7 .…”

“…Systemic involvement with hepatic, renal, or pulmonary involvement has been described in 17% of patients 17 . Other symptoms include pruritus or burning sensation and mucosa involvement in up to 20% of cases, generally in severe forms and usually restricted to the oral mucosa or rarely to the conjunctivae 1,16 . Edema of the scrotum, hands, face, purpura, petechiae, vesicles, blisters and target lesions have been reported in 50% of patients 11,17 .…”

Pustulosis exantemática generalizada aguda inducida por meropenem

“…El diagnóstico diferencial incluye otras erupciones pustulares incluidas las infecciones bacterianas o fúngicas, dermatosis neutrofílicas, vasculitis pustular, enfermedades autoinmunes ampollares y la psoriasis pustular generalizada (PPG) (17) .…”