title: Generalized pustules in a healthy woman.
abstract: 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.
authors.affiliation: New York University, Ronald O. Perelman Department of Dermatology, 530 1st Avenue, Rm. SK-7R, New York, NY 10016, USA.
authors.forename: Martha P
authors.initials: MP
authors.lastname: Arroyo
authors.forename: Patricia
authors.initials: P
authors.lastname: Heller
authors.forename: Miriam Keltz
authors.initials: MK
authors.lastname: Pomeranz
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002317:Cardiovascular Agents / Q000009:adverse effects*; D002506:Cephalexin / Q000009:adverse effects*; D004110:Diltiazem / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017444:Skin Diseases, Papulosquamous / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D002317:Cardiovascular Agents; D004110:Diltiazem; D002506:Cephalexin