Acute generalized exanthematous pustulosis induced by the antifungal terbinafine: case report and review of the literature

Abstract

Cutaneous drug reactions occur with a frequency of 1-8% and can be higher for certain classes of drugs. They can range from mild morbilliform eruptions to more severe forms such as drug-hypersensitivity syndrome, toxic epidermal necrolysis or anaphylaxis. Acute generalized exanthematous pustulosis (AGEP) is considered to be a clinical reaction pattern, which is induced in over 90% of the cases by systemic drugs. It is a rare presentation of an adverse drug reaction most frequently triggered by anti-infectious drugs. A high proportion of these cases have been attributed to aminopenicillins and macrolides. We report a terbinafine-induced AGEP in a 68-year-old male confirmed by lymphocyte stimulation in vitro, and review the published cases induced by antimycotic drugs with special emphasis on terbinafine-triggered cases.

Update on terbinafine with a focus on dermatophytoses

“…191 Severe dermatologic eruptions including toxic epidermolysis, acute generalized exanthematous pustulosis, and Steven's Johnson syndrome have also been associated with terbinafi ne use. 195 Recently, reports have also linked dermatomyositis and subacute cutaneous systemic lupus erythematosus to terbinafi ne. 196,197 In one patient, a skin eruption presenting 4 weeks after the onset of therapy and occurring with the triad of fever, hepatic dysfunction and lymphadenopathy led investigators to conclude the presence of hypersensitivity syndrome.…”

Acute Generalized Exanthematous Pustulosisafter Ingestion of Lacquer Chicken

“…AGEP is induced by systemic drugs in over 90% of cases, mainly β-lactam and macrolide antimicrobials. Calcium channel blockers, anti-malarials, and terbinafine have also been reported to cause AGEP 2,4 . In addition, viral infections, mercury exposure, Ginkgo biloba, and spider bites may serve as occasional causes [5][6][7][8] .…”

Skin Reaction After Diltiazem Hydrochloride Use in Intensive Care Unit: Case Report

“…12,13 DH, anjina pektoris ve hipertansiyon tedavisinde kullanılan bir kalsiyum kanal blokeridir. toplam 996.583 hasta üzerinde yapılan ve kalsiyum kanal blokerlerine bağlı istenmeyen ilaç reaksiyonlarını araştıran retrospektif bir çalışmada, DH deri reaksiyonları ile ilişkilendirilmiş ve en sık semptomun makülopapüler döküntü olduğu belirtilmiştir 12 .…”

“…DH kesildikten ortalama 10 gün içinde deri döküntüleri sönmek-tedir. 5,13,14 Daha önce rapor edilen hastaların bir kıs-mında ilacın kesilmesi yeterli olmuş, bir kısmında ise ilave sistemik steroid verilmesi gerekmiştir. 13,14 Çalışmamızdaki olgunun aldığı antibiyoterapinin 15 davisine başladıktan üç gün sonra deri döküntü-leri ortaya çıkmış, ilaç kesildikten ve metil prednizolon tedavisi başlandıktan sonra 10 gün içinde kaybolmuştur.…”