Severe acute generalized exanthematous pustulosis with toxic epidermal necrolysis-like desquamation: A case series of 8 patients

Huang, Simo; Ahmed, BS Amara; Hsu, Sylvia; Lee, Jason; Motaparthi, Kiran

doi:10.1016/j.jdcr.2021.07.018

Cited by 2 publications

(5 citation statements)

References 12 publications

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“…12 18 Finally, both SJS and TEN are characterised by extensive epidermal necrosis. 12 Our patient's physical signs resembled those seen in TEN, but her histological analysis was more suggestive of atypical TEN-like AGEP than TEN itself. Overall, the temporal relationship of antibiotic initiation to skin eruption is strongly suggestive of drug reaction.…”

Section: Case Reportmentioning

confidence: 45%

“…Description of the rash, its distribution, timing, and presence of other symptoms are all taken into account. The algorithm yields a score between −10 to +12, and its divided into 'no AGEP' (score −10-0), 'possible AGEP' (score 1-4); 'probable' (score 5-7) and 'definite' (score [8][9][10][11][12]. Applying the AGEP validation score, our patient received a score of +12, confirming the diagnosis.…”

Section: Case Reportmentioning

confidence: 54%

“…Drugs such as allopurinol and sulfonamides have been found to trigger SJS and TEN, but have not been associated with AGEP. 12 18 Finally, both SJS and TEN are characterised by extensive epidermal necrosis. 12 Our patient’s physical signs resembled those seen in TEN, but her histological analysis was more suggestive of atypical TEN-like AGEP than TEN itself.…”

Section: Differential Diagnosismentioning

confidence: 99%

“… 12 18 Finally, both SJS and TEN are characterised by extensive epidermal necrosis. 12 Our patient’s physical signs resembled those seen in TEN, but her histological analysis was more suggestive of atypical TEN-like AGEP than TEN itself.…”

Section: Differential Diagnosismentioning

confidence: 99%

“… 1 5 The above described presentation is by far the most common way AGEP may manifest. Unusual cases have been reported in which AGEP may present with multiple vesicles, large bullae, and diffuse skin desquamation 12 ; a presentation more commonly observed with toxic epidermal necrolysis (TEN). TEN is a separate entity with its own unique manifestations and pathophysiology; however, atypical cases of AGEP clinically presenting with overlapping TEN features (appropriately named TEN-like AGEP) have been described in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Multisystem organ failure secondary to acute generalised exanthematous pustulosis (AGEP) with atypical presentation resembling septic shock

2022

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A woman was admitted for sepsis secondary to cellulitis. After clinical improvement of sepsis, non-follicular small pustules were observed on the trunk, limbs and face while vesicles/bullae and skin exfoliation were noted on upper extremities. Larger systemic manifestations included fever, hypertension and tachycardia. Laboratory results revealed neutrophilic leukocytosis, eosinophilia, mild transaminitis and acute renal failure. Despite treatment for potential sepsis and discontinuation of offending agents, her condition worsened leading to haemodynamic instability and renal failure requiring vasopressor support, intubation and continuous veno-venous haemodialysis. Skin biopsy revealed a diagnosis of acute generalised exanthematous pustulosis (AGEP), a rare condition usually caused by antibiotic treatment. The suspected offending drug was clindamycin, with possible combined effects by metronidazole and/or vancomycin. Improvement of skin manifestations were seen within 48 hours of starting systemic steroids. Here, we present an uncharacteristic case of AGEP clinically presenting with atypical skin lesions, severe systemic involvement mimicking septic shock, which culminated in multisystem organ failure.

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Section: Case Reportmentioning

confidence: 45%