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Austin Crit Care J. 2024; 11(1): 1048.
Acute Generalized Exanthematous Pustulosis (AGEP)
Kälber KA*; Bertlich I; Enk A; Winkler JK
University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
*Corresponding author: Kälber KA University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany. Email: katharinaanna.kaelber@med.uni-heidelberg.de
Received: June 14, 2024 Accepted: July 05, 2024 Published: July 12, 2024
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A 56-year-old woman presented in reduced general condition with fever and an acute pustular rash. Previously she had received therapy with amoxicillin because of a dental infection.
A few days after start of the antibiotic therapy, pustules appeared on the legs and subsequently spread over the whole body. Laboratory tests showed elevated C-reactive protein of 169 (<5 mg/l) and leukocytosis of 27 (<10/nl) with neutrophilia and eosinophilia. Histology revealed exocytosis with subcorneal accumulation of neutrophils.
Figure 1: Physical exanimation revealed disseminated, extensive erythema with multiple non-follicular pustules. There was no involvement of the oral and genital mucous membranes.
Figure 2: Histology showed exocytosis of neutrophils with subcorneal formation of pustules.
In summary of clinical, laboratory and histological findings, the diagnosis of Acute Generalized Exanthematous Pustulosis (AGEP) was made. Therapy with 60 mg of prednisolone was initiated over four days.
AGEP is a rare, but severe cutaneous drug reaction with an incidence of 1-5 cases per million per year. Most common causes are antibiotics or other drugs with symptoms occurring within 24 to 48 hours after intake, but also bacterial or viral infections may be triggers.
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