Clindamycin-induced acute generalized exanthematous pustulosis

Abstract

Rationale: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. Sterile, non-follicular pustules overlying the erythematous skin characterize this reaction. Patient concerns: A 30-year-old Asian women presented with sterile, non-follicular lesions with pus-fluid levels on her back 2 days after taking clindamycin. Skin biopsy revealed a spongiotic change in the epidermis with a focal subcorneal pustule and perivascular eosinophil and lymphocyte infiltration. Diagnosis: Clindamycin-induced AGEP. Interventions: We discontinued clindamycin treatment and prescribed systemic corticosteroids. Outcomes: The pustule stopped spreading within 1 day and the rash improved within 2 days. Lessons: AGEP is a pustular cutaneous adverse drug reaction that can appear with pus-fluid levels, clinically mimicking Sneddon–Wilkinson disease. The differentiation between both conditions is a history of drug use, characteristic skin lesions and histopathology.

Antibiotic-Related Adverse Drug Reactions in Patients Treated on the Dermatology Ward of Medical University of Gdańsk

“…Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. It is a reaction characterized by sterile, non-follicular pustules overlying the erythematous skin [29]. It was previously associated mainly with the intake of β-lactam and macrolide antibiotics [30,31].…”

Acute Generalized Exanthematous Pustulosis Induced by Cetuximab

“…In the cases of AGEP, the symptoms of skin are always associated with fever [ 7 , 8 ]. The histopathology of skin lesions demonstrates spongiform intraepidermal and subcorneal pustules with marked papillary dermal edema, perivascular neutrophilic infiltrate, and eosinophilic exocytosis [ 9 ]. Treatment modalities for AGEP include withdrawal of offending agents, antipyretics, and systemic steroids [ 10 ].…”

“…AGEP has been described after administration of several drugs, including macrolides, amoxicillin, dexamethasone, paracetamol, nadoxolol, carbamazepine, vancomycin, and nifedipine [ 9 ]. Biological agents, compared to conventional chemotherapy regimens, have lower toxicity profiles.…”

Immediate and Delayed Hypersensitivity Reactions to Antibiotics: Aminoglycosides, Clindamycin, Linezolid, and Metronidazole

“…Other Hypersensitivity Reactions Other immunologic drug reactions that have been reported include fixed drug eruptions [42]. Other rare hypersensitivity reactions to clindamycin include DRESS/DiHS [43][44][45], SDRIFE [46], AGEP [47][48][49][50][51][52][53], and acute febrile neutrophilic dermatosis or Sweet Syndrome [54][55][56]. DRESS is a rare delayed hypersensitivity reaction often occurring 2-8 weeks from drug exposure and characterized by skin eruption, fever, eosinophilia, lymphadenopathy, and internal organ (i.e., liver, kidney, lung) involvement [43][44][45].…”

“…DRESS is most commonly caused by aromatic anticonvulsants (i.e., phenobarbital, carbamazepine, phenytoin), lamotrigine, and sulfonamides, but a few case reports diagnosed DRESS in the setting of clindamycin [43][44][45]. AGEP is an uncommon cutaneous hypersensitivity reaction with diffuse, pinpoint, sterile, non-follicular pustules overlying erythematous skin with systemic manifestations including leukocytosis with neutrophilia, fever, transaminitis, and renal insufficiency [47]. AGEP is usually druginduced and often related to antibiotics such as beta-lactams or macrolides.…”