Acute generalized exanthematous pustulosis induced by hydroxychloroquine prescribed for COVID-19

Delaleu, Jérémie; Deniau, Benjamin; Battistella, Maxime; Masson, Adèle de; Bensaïd, Benoît; Jachiet, Marie; Lazaridou, Ingrid; Bagot, M.; Archer, Gordon L.; Benattia, A.; Bergeron, Andréanne; Bondeelle, Louise; Bouaziz, Jean‐David; Bouda, D.; Boutboul, David; Brindel, Berthon I.; Bugnet, Emmanuelle; Zucman, S. Caillat; Cassonnet, S.; Lebras, Karine Celli; Chabert, Jacqueline; Chevret, Sylvie; Clement, Meredith E.; Davoine, Claire; Castro, Nathalie De; Kerviler, É. de; Margerie-Mellon, Constance de; Delaugerre, Constance; Dépret, François; Denis, B.; Djaghout, Lalia; Dupin, Clarisse; Farge‐Bancel, Dominique; Fauvaux, Catherine; Feredj, E.; Feyeux, Delphine; Fontaine, Jean‐Sébastien; Frémeaux‐Bacchi, Véronique; Galicier, Lionel; Harel, Stéphanie; AL, Jegu; Kozakiewicz, E.; LeBel, Marc; Baye, Ariane; Goff, Jennifer; Guen, Pierre Le; Lengliné, Étienne; Liégeon, Geoffroy; Lorillon, Gwenaël; Chambrin, I. Madelaine; Frémont, Grégoire Martin de; Meunier, Marie; Molina, Jean‐Michel; Morin, Florence; Oksenhendler, Éric; Tour, Régis Peffault de la; Peyrony, Olivier; Plaud, Benoît; Salmona, Maud; Saussereau, Julien; Soret, Juliette

doi:10.1016/j.jaip.2020.05.046

Cited by 20 publications

(25 citation statements)

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“…This case is unique with respect to disease severity leading to haemodynamic instability and multiorgan dysfunction. To the best of our knowledge, there is only one reported case of AGEP in patients with SARS-CoV-2 infection with no prior exposure to hydroxychloroquine (but related to cefepime administration), with some antimalarial-related cases reported in the medical literature [9][10][11] . SARS-CoV-2 skin manifestations are variable, from mild manifestations such as perniosis with generally foot compromise, moderate involvement due to morbilliform, vesicular or urticarial eruption and more severe involvement in relation to cutaneous vasculitis.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 presenting as acute generalized exanthematous pustulosis associated with multiorgan dysfunction in a 44-year-old female patient

Ordoñez

Sepulveda

Vargas

et al. 2021

Rev. Inst. Med. trop. S. Paulo

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Acute generalised exanthematous pustulosis (AGEP) is an unusual cutaneous reaction, most often related with a hypersensitivity reaction to commonly used drugs. It is characterized by an abrupt onset of a pustular rash within hours or days after drug exposure and usually resolves spontaneously within 1-2 weeks after drug discontinuation. Some cases associated with systemic involvement and shock have been reported. We present the case of a severe AGEP, manifesting in association with systemic involvement and haemodynamic instability resulting in shock and multiorgan dysfunction in an adult female patient diagnosed with COVID-19 infection. There were no identifiable associated drugs, and the patient was not initiated on antimalarial drugs. Our patient improved rapidly, both hemodynamically and dermatologically with no directed therapy.

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Section: Discussionmentioning

confidence: 99%

COVID-19 presenting as acute generalized exanthematous pustulosis associated with multiorgan dysfunction in a 44-year-old female patient

Ordoñez

Sepulveda

Vargas

et al. 2021

Rev. Inst. Med. trop. S. Paulo

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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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“…In the study cohort, seven deaths were recorded [75,91,104,132,151,182,221]. A summary description of the patients with a fatal outcome is included in Table 2.…”

Section: Resultsmentioning

confidence: 99%

Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

Vallejo-Yagüe

Torre

Mohamad

et al. 2022

JCM

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Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.

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Acute generalized exanthematous pustulosis induced by hydroxychloroquine prescribed for COVID-19

Cited by 20 publications

References 10 publications

COVID-19 presenting as acute generalized exanthematous pustulosis associated with multiorgan dysfunction in a 44-year-old female patient

COVID-19 presenting as acute generalized exanthematous pustulosis associated with multiorgan dysfunction in a 44-year-old female patient

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

Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

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