title: Acute generalized exanthematous pustulosis from dalteparin.
abstract: Heparins are widely used for the prophylaxis and treatment of venous thromboembolism. Several types of immunologically mediated reactions to heparins are reported, among them delayed-type hypersensitivity reactions with erythematous, infiltrated itchy plaques at injection sites. We describe a female patient, whose localized reaction from dalteparin was followed by a generalized rash presenting as acute generalized exanthematous pustulosis. Subcutaneous provocation testing showed cross-reactions to enoxaparin, certoparin, reviparin, nadroparin, danaparoid, fondaparinux, but not to pentosan polysulfate. The danaparoid and in a lesser extent the nadroparin patch showed pustules. Within the next day, a generalized rash developed. The upper aspect of her trunk was highly affected and showed discrete pustules. Despite the fact that low molecular-weight heparins are widely prescribed, this is, to our knowledge, the first observation of a pustular drug eruption attributable to this class of substances.
authors.affiliation: Department for Environmental Dermatology and Venereology, Medical University of Graz, Graz, Austria. peter.komericki@meduni-graz.at
authors.forename: Peter
authors.initials: P
authors.lastname: Komericki
authors.forename: Robert
authors.initials: R
authors.lastname: Grims
authors.forename: Birger
authors.initials: B
authors.lastname: Kränke
authors.forename: Werner
authors.initials: W
authors.lastname: Aberer
mesh_terms: D000208:Acute Disease; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D017985:Dalteparin / Q000008:administration & dosage / Q000009:adverse effects*; D003875:Drug Eruptions; D005076:Exanthema / Q000139:chemically induced; D005260:Female; D006801:Humans; D007267:Injections; D008875:Middle Aged; D017444:Skin Diseases, Papulosquamous / Q000139:chemically induced*; D012882:Skin Tests; D013924:Thrombophlebitis / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D017985:Dalteparin