Acute Generalized Exanthematous Pustulosis With Multiple Organ Dysfunction Syndrome

Abstract

Acute generalized exanthematous pustulosis is a rare condition characterized by sterile pustules on erythematous and edematous tissue. Mostly drug induced, this condition can also be caused by other factors. Cases due to vancomycin are rare. A 67-year-old woman with cellulitis of the left lower extremity was admitted with marked bilateral lymphedema of the lower extremities and diffuse erythema of the left lower extremity from foot to knee. She was given clindamycin and then vancomycin. On day 5, her condition worsened, with erythema involving the entire back. Although treatment with clindamycin and vancomycin was discontinued, acute generalized exanthematous pustulosis developed. After successful treatment of other complications, the skin condition improved. Because vancomycin is frequently used, clinicians should be aware of the possibility of acute generalized exanthematous pustulosis. Because the pustulosis decreases after withdrawal of the causative drug, being able to diagnose and differentiate the abnormality from other conditions is prudent. (American Journal of Critical Care. 2013;22:270-273)

Acute generalized exanthematous pustulosis: atypical presentations and outcomes

“…We herein aim to review atypical presentations and medication triggers of AGEP to assist clinicians in recognizing this condition and making appropriate therapeutic interventions. We also highlight specific cases in which the clinical course of AGEP varied to demonstrate the potential for mortality in certain settings …”

“…In virtually all TEN‐like AGEP cases, the clinical course most closely resembles AGEP with full recovery. However, four cases have been described in which AGEP mimicking TEN resulted in significant hypotension and shock with end‐organ dysfunction, although these patients recovered with aggressive supportive care and other treatments . We have recently reported a case of AGEP mimicking TEN that resulted in death .…”

Clindamycin-associated acute generalized exanthematous pustulosis

“…[3][4][5][6] Acute generalized exanthematous pustulosis appears in the first few days of drug exposure and is characterized by high fevers and widespread erythema that generally begins on the face, armpit or groin before becoming more widespread. 1,7 The erythema is studded with papules and numerous pinpoint pustules that rapidly spread to the trunk and limbs. The patient may complain of painful, pruritic skin.…”

“…Acute generalized exanthematous pustulosis is generally selflimited and resolves within 2 weeks of the discontinuation of the offending agent. [7][8][9] Although rare, AGEP can involve internal organs and can lead to mortality if the offending agent is not discontinued.…”

Vancomycin-induced acute generalized exanthematous pustulosis (AGEP) masquerading septic shock—an unusual presentation of a rare disease

“…Finally, vancomycin as a cause of AGEP is exceptionally rare. To the best of our knowledge, there have only been three previously reported cases of vancomycin-induced AGEP in the literature [ 8 , 9 , 12 ]. One case included another confounding antibiotic that is more commonly implicated in AGEP, and thus, the causation relationship was equivocal.…”