A severe presentation of acute generalized exanthematous pustulosis with non‐infectious circulatory shock in an adolescent

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a rapidly evolving adverse drug reaction with a characteristic presentation of diffuse, non-follicular, pinpoint pustules on a background of erythematous plaques, typically located in intertriginous folds. 1 AGEP is uncommon in the pediatric population and is more likely to be associated with atypical cutaneous features. 2 Drugs are the most common trigger, including penicillins, macrolides, sulfonamides, antifungals, diltiazem, hydroxychloroquine, antiinflammatory medications, and anti-epileptics. 3 In the pediatric population, it is suggested that viral infections may have a greater association with AGEP. 2,4 The traditional clinical course of AGEP in pediatric patients is an acute presentation of the classic eruption with associated high-grade fever and elevated neutrophil counts. 4 Although the clinical picture is concerning, AGEP is typically self-limited, with rapid recovery following cessation of the causative agent and an overall favorable prognosis. 1 Systemic involvement of AGEP with reports of hemodynamic