A healthy 47-year-old woman developed diffuse pustules and
edema of the skin after exposure to
diltiazem and
cephalexin. Bacterial, fungal and viral cultures were sterile suggesting a noninfectious etiology. A skin biopsy showed spongiosis, subcorneal collections of neutrophils, papillary dermal
edema and a superficial perivascular mixed cell infiltrate. The clinical and histopathologic findings were consistent with
acute generalized exanthematous pustulosis (AGEP). The patient was treated with supportive care and the pustular
dermatitis cleared. AGEP is a rare complication of
drug therapy and should be considered in the differential diagnosis of patients presenting with acute onset pustular
dermatitis.
Drug reactions are an uncommon and unpredictable complication of medical
therapy. Cutaneous
drug reaction rates occur with a frequency of 1% to 8% and can be higher for certain classes of drugs. They can range from mild morbilliform eruptions to more severe forms such as
drug-hypersensitivity syndrome,
toxic epidermal necrolysis or
anaphylaxis. Acute generalized exanthermatous pustulosis (AGEP) is a rare presentation of a
drug reaction and can be difficult to distinguish from other pustular
dermatoses. Herein we review a case of AGEP and include a discussion of salient clinical and histological features of AGEP.