Acute generalized exanthematous pustulosis due to diltiazem: confirmation by patch testing

A Systemic Reaction to Patch Testing for the Evaluation of Acute Generalized Exanthematous Pustulosis

“…15 Although the patch test reaction in most AGEP cases is limited to the test site, there are a few reports of reactions spreading beyond this site, most of them attributed to diltiazem hydrochloride. Nishimura et al 16 reported a generalized AGEP-like reaction caused by a patch test with diltiazem; Vincente-Calleja et al 17 described the appearance of a diffuse pruritic eruption on the neck, abdomen, and patch test area-which resolved in a few days-after a positive patch test with diltiazem; and Wakelin and James 18 reported a positive patch test with diltiazem accompanied by a mild eczematous reaction on both forearms.…”

Acute Generalized Exanthematous Pustulosis due to Teicoplanin

“…Wolkenstein et al [8] have shown a 50% sensitivity of patch testing in cases of AGEP. The case reports in the recent literature almost revealed a positive patch testing [3,[5][6][7]. Therefore, some authors proposed that the sensitivity of patch testing in AGEP may be greater than 50%, but this may reflect the publication bias [5].…”

“…The role of patch testing in confirming the causative agent of AGEP has been well recognized in recent years [3,[5][6][7][8]. Wolkenstein et al [8] have shown a 50% sensitivity of patch testing in cases of AGEP.…”

“…In most cases, the causative agent is a drug, mainly ß-lactam and macrolide antimicrobials [3]. The other causative factors include viral infections and hypersensitivity to mercury [1,2].…”

Acute Generalised Exanthematous Pustulosis with Subepidermal Blisters of the Distal Extremities Induced by Diltiazem

“…In addition, viral infections have been suspected to trigger AGEP in a minor fraction of reported cases [1] . In general, the diagnosis of AGEP is confi rmed by the combination of clinical history, morphology of lesions, clinical course and histological features [1][2][3][4] . AGEP typically presents with non-follicular pustules occurring on diffuse and oedematous erythema predominantly in the intertriginous areas and/or the face [1,3] .…”