A Case of Acute Generalized Exanthematous Pustulosis after Injection of an Erythropoiesis-Stimulating Agent

Suh, Hyun Yi; Bae, Jooyoon; Kim, Hong Lim; Kim, Kyung Ho; Cha, Ran-hui; Ahn, Ji Young; Youn, Jai Il; Park, Mi Youn

doi:10.5021/ad.2018.30.1.100

Cited by 5 publications

(3 citation statements)

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“…Previous analysis of drug‐specific CD4+ T‐cells cells from patients with AGEP shows a predominant Th1 type cytokine profile with increased interferon (IFN)‐γ and granulocyte/macrophage colony‐stimulating factor production . However, other studies about AGEP have reported elevated interleukin‐5, which could explain the characteristic eosinophilia in these cases …”

Section: Introductionmentioning

confidence: 99%

“…12,15 However, other studies about AGEP have reported elevated interleukin-5, which could explain the characteristic eosinophilia in these cases. 16,17 Plasmacytoid dendritic cells (PDCs) are not present in normal skin but have been established as an important source of IFN-α/β production in lesions of cutaneous lupus erythematosus 18 and psoriasis. 19 PDCs are a subset of dendritic cell precursors in human peripheral blood and organized lymphoid tissue (peripheral lymph nodes and tonsils), 20,21 which can be identified in blood and tissue with antibodies to CD123 (interleukin-3 receptor α chain).…”

Section: Introductionmentioning

confidence: 99%

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Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein

et al. 2019

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Background Distinguishing acute generalized exanthematous pustulosis (AGEP) and pustular psoriasis (PS) can be challenging. Staining for plasmacytoid dendritic cells, or PDCs (producer of IFN‐α/β), and MxA (an IFN‐α/β inducible protein) may help discriminate these entities. Methods Forty‐three cases of AGEP and PS were compiled from two academic institutions. All cases were examined for CD123+ PDCs, eosinophils, acanthosis, papillomatosis, suprapapillary plate thinning, tortuous dilated capillaries, single necrotic keratinocytes, papillary dermal edema, vasculitis, eosinophil exocytosis, intraepidermal pustules, and subcorneal pustules. A subset of cases (n = 26) was stained for MxA. Results Perivascular and intraepidermal PDCs, dilated tortuous vessels, and MxA expression in the dermal inflammatory infiltrate were significantly (P < 0.05) in favor of a diagnosis of PS. The absence of PDCs and presence of eosinophils favored a diagnosis of AGEP (P < 0.05). Conclusions We found compelling evidence for the use of CD123 to highlight PDCs in these cases. The presence of PDCs and expression of MxA in dermal inflammatory infiltrate, as well as absence of eosinophils and presence of tortuous dilated capillaries favored a diagnosis of PS. Expression of MxA in the dermal infiltrate corresponds with a Th1 pathway in PS and may indicate a Th1 component in the early initial phase of AGEP.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein

et al. 2019

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“… 5 A genetic predisposition may underpin the development of AGEP as human leukocyte antigens B51, DR11, and DQ3 are more frequently observed in patients with AGEP. 7 Moreover, mutations in the IL- 36RN gene, encoding the IL-36 receptor antagonist, may be responsible for the increased downstream production of IL-1, IL-6, and IL-8. 5 , 6 However, the role of ultraviolet (UV) in triggering or exaggerating AGEP has not been established.…”

Section: Discussionmentioning

confidence: 99%

A case report of terbinafine-induced acute generalized exanthematous pustulosis in a striking photodistributed pattern

Lange,

Madden,

Parker

2024

SAGE Open Medical Case Reports

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Acute generalized exanthematous pustulosis is a rare severe cutaneous adverse reaction that classically presents in intertriginous or flexural areas and subsequently spreads diffusely across the trunk and extremities. To date, few cases of acute generalized exanthematous pustulosis arising in a photodistributed pattern are documented. Herein, we describe the second known case of photodistributed generalized exanthematous pustulosis arising in association with oral terbinafine use, providing a summary of the previously documented cases along with exploration of the potential pathophysiological mechanisms for this cutaneous reaction.

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Clinical presentation and management of atypical and recalcitrant acute generalized exanthematous pustulosis

Hadavand

Kaffenberger

Cartron

et al. 2022

Journal of the American Academy of Dermatology

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A Case of Acute Generalized Exanthematous Pustulosis after Injection of an Erythropoiesis-Stimulating Agent

Cited by 5 publications

References 5 publications

Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein

Distinguishing pustular psoriasis and acute generalized exanthematous pustulosis on the basis of plasmacytoid dendritic cells and MxA protein

A case report of terbinafine-induced acute generalized exanthematous pustulosis in a striking photodistributed pattern

Clinical presentation and management of atypical and recalcitrant acute generalized exanthematous pustulosis

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