title: Valdecoxib-associated acute generalized exanthematous pustulosis.
abstract: AGEP (acute generalized exanthematous pustulosis) is a relatively rare exfoliative skin syndrome consisting of generalized eruption of pustules in response to medication or infection. Because AGEP may have other systemic manifestations, such as renal failure, hyperthermia, lab abnormalities, and/or hemodynamic instability, it is important to make the distinction between AGEP and other life-threatening generalized skin diseases, such as toxic epidermal necrolysis (TEN). Here we present a case of AGEP in response to valdecoxib, which has not previously been described in the literature. The patient presented with profound hypotension requiring fluid and vasopressor support and was referred to the burn service for treatment of TEN, but her skin lesions were inconsistent with this diagnosis. A dermatology consult was obtained and suggested a diagnosis of AGEP, which a biopsy confirmed. TEN and AGEP present with similar history, types of associated drugs, and immunology. Both can be associated with antibiotics, non-steroidals, and anticonvulsants, but AGEP is more frequent with aminopenicillins, while TEN is associated more often with sulfonamide antibiotics. Both disorders have a proposed T cell-mediated immune response, but they differ in the mechanism. A description of valdecoxib and its role as a sulfonamide in producing cutaneous reactions is also provided.
authors.affiliation: Department of Surgery, North Carolina Jaycee Burn Center CB# 7600, University of North Carolina Hospitals, 101 Manning Drive, Chapel Hill, NC 27514, USA.
authors.forename: Faera L
authors.initials: FL
authors.lastname: Byerly
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Nelson
authors.forename: Robert P
authors.initials: RP
authors.lastname: Granko
authors.forename: Dean S
authors.initials: DS
authors.lastname: Morrell
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000188:drug therapy; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology*; D005076:Exanthema / Q000139:chemically induced* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007555:Isoxazoles / Q000009:adverse effects*; D008875:Middle Aged; D017444:Skin Diseases, Papulosquamous / Q000139:chemically induced* / Q000175:diagnosis; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis; D013449:Sulfonamides / Q000009:adverse effects*; D000096926:Benzenesulfonamides
chemical_list: D016861:Cyclooxygenase Inhibitors; D007555:Isoxazoles; D013449:Sulfonamides; C406224:valdecoxib; D000096926:Benzenesulfonamides