Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab

Abstract

Acute generalized exanthematous pustulosis is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base. Most cases of acute generalized exanthematous pustulosis (AGEP) clear quickly with a systemic corticosteroid, but severe or recalcitrant cases may need other systemic therapies. In this case, a man in his 40 s with a history of psoriasis consulted a physician about widespread erythema, pustules, target lesions, and fever after the administration of a quadruple antituberculosis drug. Routine laboratory testing revealed elevated white blood cell count and C-reactive protein. The histopathology showed subcorneal pustules, spongiosis as well as lymphocyte and eosinophils infiltration in the dermis. The patient was diagnosed with definitive AGEP according to the diagnostic score from the EuroSCAR study. Cutaneous lesions especially pustules and erythema multiforme-like lesions on the upper arms and palms are crucial for distinguishing AGEP from Generalized pustular psoriasis. The patient was treated with secukinumab as a result of his failure to respond to topical corticosteroids and constrain of systemic steroids. Remission with secukinumab therapy was safe without increased risks of infections. This case indicates that secukinumab is a potential therapy that can rapidly improve the clinical symptoms of AGEP.

Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management

“…Cyclosporine is another option for severe AGEP with similar efficacy to oral corticosteroids that may be used in steroid-refractory cases or in patients with contraindications to steroid therapy [ 218 ]. Secukinumab and infliximab have also been successfully used to treat refractory cases that are not responsive to drug discontinuation, supportive care, or steroids [ 219 , 220 ]. Due to the immunologic nature of AGEP, it is likely that other biologic medications targeting the aforementioned IL pathways can be utilized; however, further study is needed to determine the necessity, safety, dosing, and outcomes.…”

Pustulosis exantemática generalizada aguda por medicamentos no habituales

“…Como desencadenante de la PEGA, la hidroxicloroquina puede generar un período de latencia prolongado atípico y ser potencialmente recalcitrante al tratamiento inicial. Por lo tanto, una opción terapéutica es la ciclosporina en dosis de 4-5 mg/kg/día y los anticuerpos monoclonales anti-interleuquina 17 (IL-17) como el ixekizumab y el secukinumab 4,19,20 .…”

Helper T cell subsets: Development, function and clinical role in hypersensitivity reactions in the modern perspective

“…Anti -IL-5 or IL-5 receptor monoclonal antibodies such as mepolizumab, benralizumab and reslizumab have been successfully used to treat DRESS syndrome patients in a number of case reports, including cases which responded suboptimally to systemic corticosteroids [ 79 , 113 ]. There have also been case reports of successful treatment of refractory and severe AGEP using anti -IL-17 monoclonal antibodies such as secukinumab and ixekizumab [ [114] , [115] , [116] ]. On top of benefiting the corticosteroid-refractory patients, the use of cytokine-specific biologics may also achieve steroid-sparing effect, thus reducing the side effects from corticosteroids [ 113 ].…”