Acute Generalized Exanthematous Pustulosis Induced by Salazosulfapyridine in a Patient with Ulcerative Colitis

Abstract

We report a case of acute generalized exanthematous pustulosis (AGEP) induced by salazosulfapyridine in a patient with ulcerative colitis. A 26-year-old Japanese man, who had been receiving medical attention for ulcerative colitis for one year, presented with diffuse erythema and pustules on his face and trunk, malaise, and fever up to 39 degrees C one day after the administration of salazosulfapyridine. A skin biopsy specimen disclosed intracorneal pustule composed of neutrophils and lymphohistiocytic infiltrate in the dermis. A drug lymphocyte stimulation test for salazoslufapyridine was positive, but the patch test was negative. Immunological mechanisms are suggested in the pathogenesis of psoriasis and ulcerative colitis. We suspect that a similar immunological pathway played a role in the pathogenesis of AGEP appearing in psoriasis and ulcerative colitis.

Acute generalized exanthematous pustulosis caused by morphine, confirmed by positive patch test and lymphocyte transformation test

“…[13][14][15][16][17] In most of these cases, however, patch tests were negative or not performed. 13,14,16,17 The pathogenesis of AGEP remains hypothetical. Patch testing may provoke relapses, 18,19 supporting the idea that the immune system is involved and that a positive test has relevance.…”

Do the Physical and Histologic Features and Time Course in Acute Generalized Exanthematous Pustulosis Reflect a Pattern of Cytokine Dysregulation?

“…1 However, the character, the associated symptoms, and the course of AGEP are unlike those of psoriasis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] In AGEP the lesions are polymorphous; they develop rapidly with induration and/or pustulation. AGEP also resolves rapidly with desquamation, with or without therapy.…”

“…Although AGEP is usually reported with drugs used to treat known or suspected underlying infections, it has also been associated with viral infections without therapy, to an ever wider spectrum of other classes of drugs in patients without associated infections, to dietary supplements, after exposure to mercury, and after radiation. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Antibiotics are the most common medications associated with these eruptions, usually in patients with underlying infections. 1,12 This is also the case in the patients in our study; however, antifungal medications were implicated in approximately 25% of our patients.…”

Pyoderma vegetans and ulcerative colitis

“…Biopsy findings are often non-specific. 16 Subcutaneous abscesses have been observed in a patient with ulcerative colitis showing a clinical course paralleling that of bowel disease. 5,11,12 The absence of coexisting typical lesions of pyoderma gangrenosum and the complete rapid healing after antibiotic therapy do not allow us to interpret our case as a vegetans variant of pyoderma gangrenosum.…”