Generalized pustular drug eruptions: confirmation by in vitro tests

Abstract

The diagnosis of pustular drug eruptions depends on circumstantial evidence, some characteristic clinicopathological findings and exclusion of alternative diagnoses of other disseminated pustular eruptions. In vitro tests, namely MIF and MCD tests, are a useful diagnostic aid in the identification of the offending drugs.

Acute generalized exanthematous pustulosis

“…The involvement of T cells in the pathogenesis of AGEP has also been supported by the results of in-vitro tests toward culprit drugs [15][16][17].…”

“…A diagnostic role was also reported for the in-vitro release of the lymphokine macrophage migration inhibition factor and for the mast cell degranulation test in a series of patients with pustular drug eruptions consistent with AGEP [16]. In view of the limited data concerning the diagnostic role of in-vitro tests in AGEP, further studies are required.…”

“…Rashes similar to AGEP have been described in the literature as toxic pustuloderma or pustular drug rash [16,56,57]. A variety of skin diseases with sterile pustules, mainly in nonfollicular distribution, may be considered in the differential diagnosis.…”

Acute generalized exanthematous pustulosis: an overview of the clinical, immunological and diagnostic concepts

“…The Table 1. Most frequently mentioned drugs causing acute generalized exanthematous pustulosis Antibiotics Ampicillin [11,12,19,[34][35][36] Amoxicillin [11,12,19,[34][35][36] Amoxicillin/clavulanic acid [34] Clindamycin [34,35] Cotrimoxazole [12,34,35] Erythromycin [11,12,19,[34][35][36] Metronidazole [3,11,34,35,37] Penicillin [11,12,19,34,35,37] Pristinamycin [12,19,34,35] Spiramycin [12,19,34,35] Anticonvulsants Carbamazepine [3,12,19,34,35,38] Antifungal agents Nystatin ...…”

Ciprofloxacin-Induced Acute Generalized Exanthematous Pustulosis Mimicking Bullous Drug Eruption Confirmed by a Positive Patch Test

“…Additional secretion of interleukin-8 not only by T cells but also by keratinocytes attract neutrophils and transform vesicles into pustules. The value of other in vitro tests, such as the macrophage migration inhibition factor test and the mast cell degranulation test, in the diagnosis of AGEP is unclear, but they have been shown to be helpful in detecting the causative drug at least in some cases [19]. …”