Amiodarone

Abstract

Acute generalised exanthematous pustulosis: case reportA 69-year-old woman developed acute generalised exanthematous pustulosis (AGEP) during treatment with amiodarone for supraventricular extrasystoles [time to reaction onset not stated].The woman, who had a history of supraventricular extrasystoles, presented with malaise, fever, and small non-follicular pustules on the background of erythema in the groin and axillae. Twenty-four hours prior to the presentation, her antiarrhythmic treatment was changed from bisoprolol to amiodarone [dosage and route not stated]. On admission, she showed dyspnoea, tachypnoea, tachycardia and suboptimal oxygen saturation. Nikolsky sign was negative, and involvement of her mucous membrane was observed. Laboratory tests revealed neutrophilia and leucocytosis. Her blood cultures were negative, and X-ray findings were normal. She was suspected to have AGEP.The woman's treatment with amiodarone was stopped, and skin biopsy was performed. She was treated with meprednisone for her pulmonary symptoms. Histopathology of the biopsied sample showed sub-corneal pustules without necrotic keratinocytes. The EuroSCAR score was 11, which was indicative of definite AGEP. Despite initial treatment, her lesions extended and evolved in 24h. Further, she developed diarrhoea, and she also developed targetoid and purpuric lesions in the gluteal and thigh area. The bullous lesions led to development of small erosions on her flanks. The Nikolsky sign was still negative. The prolonged half-life of amiodarone and insufficient intestinal absorption of corticosteroid might have caused torpid progression. It was thought that she could have an overlapping of two adverse drug reactions or she could have a different drug reaction like toxic epidermal necrolysis (TEN). A skin biopsy was again performed, and the histopathology of the biopsied sample was again consistent with AGEP. Meprednisone dose was increased, and was administered intravenously. Eleven days after the onset, her systemic symptoms and skin lesions resolved with skin desquamation. However, after 5 months of onset of symptoms, she continued to have recurrences every time the corticosteroid treatment was stopped. Distel C, et al. Acute generalized exanthematous pustulosis with features mimicking toxic epidermal necrolysis secondary to amiodarone. Anais Brasileiros de Dermatologia 20: 11 May 2020.