title: Acute generalized exanthematous pustulosis and toxic epidermal necrolysis induced by hydroxychloroquine.
abstract: Acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN) are both severe cutaneous adverse reactions, mostly to drugs. Although predominantly involving skin, they differ significantly in presentations, prognosis, pathology, immunogenesis, and treatment. They have very rarely been described to occur simultaneously in a patient, manifesting as AGEP-TEN overlap. We describe a 67-year-old Chinese lady with systemic lupus erythematosus who presented with features of AGEP but evolved to AGEP-TEN overlap as an adverse reaction to hydroxychloroquine (HCQ) treatment. This case is the first reported case of AGEP-TEN overlap secondary to HCQ and highlights the need for constant surveillance for rare adverse events that may manifest even after decades of use of the drug worldwide.
authors.affiliation: Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore, Singapore. aisha_lateef@nuh.com.sg
authors.forename: Aisha
authors.initials: A
authors.lastname: Lateef
authors.forename: Kong-Bing
authors.initials: KB
authors.lastname: Tan
authors.forename: Tang Ching
authors.initials: TC
authors.lastname: Lau
mesh_terms: D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001379:Azathioprine / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy*; D012872:Skin Diseases, Vesiculobullous / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D006886:Hydroxychloroquine; D016572:Cyclosporine; D001379:Azathioprine