Clinicopathologic Manifestations of 36 Korean Patients with Acute Generalized Exanthematous Pustulosis: A Case Series and Review of the Literature

Abstract

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare and severe subtype of drug eruption, characterized by acute, extensive, non-follicular, sterile pustules on an erythematous background, accompanied by fever and leukocytosis. Objective: The purpose of this study was to characterize AGEP in Korean patients in terms of clinical, laboratory, and pathologic findings. Methods: Thirty-six patients (M:F=17:19) with AGEP were identified from an extensive review of medical records over a 15 year period. All patient cases were confirmed by biopsy and fulfilled the diagnostic criteria. Results: The patient ages ranged from 4∼80 years (37.6±19.4). The incubation period was 1∼23 days. The duration of disease was 5∼14 days. Neutrophilia (36/36), high CRP (14/36), and eosinophilia (30/36) were common laboratory findings. A history of drug administration existed in 23 of 36 patients; herbal medications, lacquers and radiocontrast media were the unique causative drugs. Spongioform subcorneal or intraepidermal pustules in the epidermis was observed in all patients. Thirty-six patients were subdivided into 2 groups: group A (n=23) was strongly associated with known agents; and group B (n=13) had no identified causative agents. There was no significant difference between the 2 groups. Conclusion: Our results demonstrate the characteristic features of AGEP in Korean patients as follows: lower identification of causative agents; herbal medications, lacquers, and radiocontrast media were the main causative agents; and no significant differences existed between the 2 groups. (Ann Dermatol 22(2) 163∼169, 2010)

Idiosyncratic Adverse Drug Reactions: Current Concepts

“…Acute Generalized Exanthematous Pustulosis. Acute generalized exanthematous pustulosis is characterized by an acute onset of a noninfectious pustular skin reaction, usually starting on the face, neck, groin and axillae, fever, and neutrophilia (Roujeau et al, 1991;Choi et al, 2010). The major drugs associated with this ADR are antibiotics.…”

Acute generalized exanthematous pustulosis induced by the essential oil of Pistacia lentiscus

“…In a group of 36 Korean patients with AGEP, herbal medicine was incriminated in 4 cases (11%). Herbal medications are an easily accessible remedy compared with conventional treatment in Korea, and are less expensive 6 . It is not unusual for herbal medications to cause reactions, as some have been shown to contain be contaminated with microorganisms or to contain synthetic drugs or unsafe levels of heavy metals (including mercury).…”

Acute Generalized Exanthematous Pustulosis Due to Pyrazinamide in a Patient Receiving Antituberculous Treatment: A Case Report

“…Ancak bu akut faz reaktanlarının yüksekliğinin nedeni konusunda yeterli veri yoktur. Şüpheli tedavinin kesilmesiyle düzelmenin başlaması da tanıyı destekler (6)(7)(8)(9). İlaç kesildikten sonra hastalık kendini sınırlayan karakterdedir.…”