title: Acute generalized exanthematous pustulosis (AGEP) triggered by a spider bite.
abstract: BACKGROUND
  Acute generalized exanthematous pustulosis (AGEP) is a rare and severe cutaneous reaction usually triggered by drugs. Other causative factors such as viral infections are rarely involved. In this study, we report a case of AGEP caused by a spider bite.
  
  
  METHODS
  A 56-year-old woman was referred to the allergy unit after a spider bite at the left popliteal fossa, while gardening, 5 days earlier. The offending spider was captured and identified by an entomologist as belonging to the Loxosceles rufescens species. No acute reaction was observed; however, after 24 hours, due to the occurrence of typical dermonecrotic skin lesions associated with erythema and edema, Cefuroxime and Clindamycin were administered intramuscularly after medical advice was given. Almost 72 hours after the spider bite, an erythematous and partly edematous eruption appeared locally in the gluteus area bilaterally, which progressively expanded to the trunk, arms and femors. Within 24 hours dozens of small, pinhead sized, non-follicular pustules were present, mainly in the folds. The patient complained of a burning sensation of the skin in addition to pruritus; and simultaneously had a fever of 38-39 degrees C as the eruption expanded.
  
  
  CONCLUSIONS
  A spider bite may represent a possible causative factor of AGEP. A spider's venom contains sphingomyelinase that stimulates the release of IL8 and GM-CSF, which are involved in AGEP pathogenesis. Whether or not the con-current use of antibiotics has an effect in AGEP appearance when combined with a spider's venom, cannot be excluded.
authors.affiliation: Allergy Clinical Research Center, Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Medical School, University of Athens, Greece. mak-mik@hol.gr
authors.forename: Michael
authors.initials: M
authors.lastname: Makris
authors.forename: Nektaria
authors.initials: N
authors.lastname: Spanoudaki
authors.forename: Fani
authors.initials: F
authors.lastname: Giannoula
authors.forename: Caterina
authors.initials: C
authors.lastname: Chliva
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antoniadou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kalogeromitros
mesh_terms: D000818:Animals; D002444:Cefuroxime / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use; D004487:Edema / Q000209:etiology / Q000473:pathology; D004890:Erythema / Q000209:etiology / Q000473:pathology; D005076:Exanthema / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012867:Skin / Q000473:pathology; D012882:Skin Tests; D001098:Spider Bites / Q000150:complications* / Q000188:drug therapy
chemical_list: D002981:Clindamycin; D002444:Cefuroxime