Acute generalized exanthematous pustulosis caused by varenicline

Abstract

Acute generalized exanthematous pustulosis caused by vareniclineEditor Varenicline is a new product indicated for smoking cessation. Cutaneous side-effects are rare. To our knowledge, we report the first case of severe drug-induced eruption in the form of acute generalized exanthematous pustulosis (AGEP) induced by varenicline.A 41-year-old woman smoker (25 packs per year) was treated with varenicline for the purpose of smoking cessation. Five days later, a submammary erythema appeared and rapidly spread to the trunk and the extremities despite discontinuation of the treatment. The patient was referred to our clinic 2 days later. She had fever of 39.2 °C and asthenia. There was a diffuse pruritic rash with intense erythema of the trunk and skin folds covered with pustular lesions, oedematous facial involvement, maculopapular and vesiculopustular lesions of the extremities with palmoplantar pseudo-dyshydrosis (Figs 1, 2). There were inguinal and axillary centimetric adenopathies. There was no involvement of mucous membranes, Nikolski's sign or bullous lesion. The rest of the physical examination was unremarkable.The laboratory tests revealed leukocytosis of 24 700/mm 3 with 21 700 neutrophils and 1000 eosinophils. The level of C-reactive protein was elevated at 223 mg/L. The renal and hepatic functions were normal. The bacteriological samples were sterile. Serological LETTERS TO THE EDITOR

Acute generalized exanthematous pustulosis caused by varenicline

“…The two reported cases of AGEP resolved without recurrence after the discontinuation of varenicline . Patch tests were performed in only one of these cases and were negative, as in the present patient.…”

“…The two reported cases of AGEP resolved without recurrence after the discontinuation of varenicline . Patch tests were performed in only one of these cases and were negative, as in the present patient. However, this result does not refute the culpability of varenicline because nearly 50% of epicutaneous tests are negative in AGEP patients …”

“…Its main adverse events are headache, nausea, and abdominal pain and increased risk for suicide and myocardial infarction . Reported mucocutaneous complications are rare and include xerostomia and three cases of generalized eruptions (one of maculopapular exanthema and two of AGEP). In addition, angioedema, multiform exudative erythema, and Stevens–Johnson syndrome are listed on the product specification sheet.…”

Acneiform Eruption Caused By Varenicline Tartrate: A Case Report

“…Post-marketing reports of varenicline contain hypersensitivity reactions including angioedema and severe skin reactions including eritema multiforme and Stevens-Johnsons Syndrome [3,5]. There have also been reports of serious cutaneous reactions, including diffuse exanthema [11], acute generalized exanthematous pustulosis [12,13] in the litherature. Generalized severe rash and fever started 5-7 days after taking varenicline, was seen in these cases.…”

Mucocutaneous complications of smoking cessation therapies

“…2 Although the potential psychiatric (eg, vivid dreams, suicidality), cardiovascular (eg, increased risk of myocardial infarction and other cardiovascular events), and gastrointestinal (eg, abdominal pain, nausea) adverse effects of varenicline have been more publicized, 2 mucocutaneous complications include xerostomia, 2 diffuse exanthema, 10 and acute generalized eczematous pustulosis. 11 Cytisine is an older a 4 b 2 nicotinic acetylcholine receptor partial agonist that is not FDA approved, but used in Europe. 12 Cytisine is inexpensive (eg, a course of treatment is equivalent to $15 USD in Poland and $6 USD over the counter in Russia), but unavailable in the United States, despite being attainable in former socialist economy countries for more than 4 decades.…”