Acute generalized exanthematous pustulosis after
            <scp>COVID</scp>
            ‐19 treatment with hydroxychloroquine

Litaiem, Noureddine; Hajlaoui, Khaoula; Karray, M.; Slouma, M.; Zéglaoui, Faten

doi:10.1111/dth.13565

Cited by 25 publications

(29 citation statements)

References 6 publications

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“…An elderly patient with COVID-19 pneumonia who had received treatment with lopinavir/ ritonavir and hydroxychloroquine developed a diffuse, pruritic pustular eruption on the extremities and trunk; targetoid lesions were also present [37]. Other reports of acute generalized exanthematous pustulosis (AGEP) attributed to hydroxychloroquine in the setting of SARS-CoV-2 infection, including fatal cases, have also been described [38,88]. Table 2 lists histopathologic findings.…”

Section: Acute Generalized Exanthematous Pustulosismentioning

confidence: 99%

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Mawhirt

Frankel

Diaz³

2020

Curr Allergy Asthma Rep

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Purpose of Review COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge. Recent Findings Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. Summary In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population. Keywords COVID-19. SARS-CoV-2. Cutaneous manifestations. Dermatologic. Rash. Contact dermatitis Abbreviations AAD American Academy of Dermatology ACD Allergic contact dermatitis ACE2 Angiotensin-converting enzyme 2 AD Atopic dermatitis AGEP Acute generalized exanthematous pustulosis ARDS Acute respiratory distress syndrome COVID-19 Coronarvirus viral disease 2019 CSSV Cutaneous small vessel vasculitis DIC Disseminated intravascular coagulation DiHS/DRESS Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms HCW Health care worker ICD Irritant contact dermatitis ITP Immune thrombocytopenic purpura PPE Personal protective equipment PT Patch test RT-PCR Reverse transcriptase polymerase chain reaction SARS-CoV-2 Severe acute respiratory distress syndrome coronavirus 2 SDRIFE Symmetrical drug-related intertriginous and flexural exanthema This article is part of the Topical Collection on Allergic Skin Diseases

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Section: Acute Generalized Exanthematous Pustulosismentioning

confidence: 99%

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Mawhirt

Frankel

Diaz³

2020

Curr Allergy Asthma Rep

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“…Eventually, the skin lesions were significantly improving after hydroxychloroquine withdrawal. The relation of AGEP and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or its treatment remain poorly understood [4]. The AGEP generally occurs within 48 hours of treatment initiation but, AGEP arising after hydroxychloroquine treatment is distinguishable by longer incubation period it can be up to two to three weeks.…”

Section: Discussionmentioning

confidence: 99%

Acute Generalized Exanthematous Pustulosis After COVID‐19 Infection: A Case Report From Saudi Arabia

Alzahrani¹,

Moussa²,

Alfaraj³

2020

Cureus

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There is a dearth of robust evidence regarding coronavirus disease 2019 (COVID-19)-related coetaneous manifestations, complications and adverse treatment events. Upon review of the literature there are only a few cases reported of acute generalized exanthematous pustulosis (AGEP) in COVID-19 patients after treatment. Therefore, we are reporting a case of a 34-year-old male not known to have any chronic illness. His severe COVID-19 infection resolved four days prior to presentation to the Emergency Department with pustular rash on erythematous base over his face, neck, upper limbs, anterior and posterior trunk including oral cavity and tounge. The rash started after he took azithromycin, oseltamivir, ribavirin, lopinavir, hydroxychloroquine, prednisolone, ceftriaxone, clindamycin, interferon (IFN) beta, and ceftazidime for COVID-19. Skin punch biopsy was done and he was diagnosed with AGEP but it was still not known if it was related to COVID-19 or a drug-induced condition. Patient was treated with betamethasone valerate 0.1% ointment and lotion, promethazine hydrochloride 25mg tablet, paracetamol 500mg tablet, calcipotriol 50mcg/g and betamethasone 0.5mg/g gel. He discharged the same day to manage at home despite not improving. In the end, we found only a few studies that describe the cutaneous manifestations of COVID-19 infection, which were mainly case reports. We can't be sure that AGEP is a late and severe complication of COVID-19 infection. However, AGEP could be a rare adverse effect of hydroxychloroquine therapy. Improving the knowledge about a wide range of different signs and symptoms of the disease and its severity in addition to all possible adverse treatment events and complications can improve patient safety, survival rate, and quality of life.

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“…He was, however, diagnosed with COVID-19 on the same day that his fever began and his rash appeared. To the best of our knowledge, this is the second reported case of AGEP in a patient with COVID-19 [ 7 ]. In the other reported case, the patient developed AGEP 18 days after hydroxychloroquine was initiated as treatment for COVID-19 infection [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this is the second reported case of AGEP in a patient with COVID-19 [ 7 ]. In the other reported case, the patient developed AGEP 18 days after hydroxychloroquine was initiated as treatment for COVID-19 infection [ 7 ]. In regards to our patient, we hypothesize that his vigorous immune response to COVID-19, coupled with concurrent cefepime use, may have triggered the appearance of AGEP.…”

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Acute Generalized Exanthematous Pustulosis Following Treatment with Cefepime in a Patient with COVID-19 without the Use of Hydroxychloroquine

2020

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Acute generalized exanthematous pustulosis after COVID ‐19 treatment with hydroxychloroquine

Cited by 25 publications

References 6 publications

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers

Acute Generalized Exanthematous Pustulosis After COVID‐19 Infection: A Case Report From Saudi Arabia

Delayed Presentation of Acute Generalized Exanthematous Pustulosis Following Treatment with Cefepime in a Patient with COVID-19 without the Use of Hydroxychloroquine

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