Acute generalized exanthematous pustulosis in a patient after stem cell transplantation.
BACKGROUND
a severe generalized pustular eruption occurred several months after allogeneic hematopoietic stem cell transplantation for multiple myeloma in a patient being treated with antibiotics for respiratory infection. Neither he nor his donor had a history of psoriasis.


METHODS
the patient was treated with drug withdrawal and administration of cyclosporine and methylprednisolone without improvement; later, acitretin and methylprednisolone were used successfully. The eruption slowly subsided, and therapy was discontinued. Four months later, the patient experienced a recurrent severe pustular eruption associated with fever and leukocytosis, and the same treatment was used successfully again.


CONCLUSIONS
the patient has not experienced relapses in the ensuing 3 years. Acute generalized exanthematous pustulosis is a rare cutaneous adverse reaction triggered most commonly by drugs with a tendency to resolve spontaneously. The surprisingly prolonged, refractory, and relapsing course of the eruption in our patient might be due to the immune alteration and the polypharmacologic therapy after stem cell transplantation.
Cetkovská
Petra
P
Department of Dermatovenereology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic. cetkovska@fnplzen.cz
Benáková
Nina
N
D017255:Acitretin / Q000008:administration & dosage; D056150:Acute Generalized Exanthematous Pustulosis / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D009101:Multiple Myeloma / Q000601:surgery; D011183:Postoperative Complications / Q000276:immunology*; D012008:Recurrence; D012867:Skin / Q000473:pathology
D000893:Anti-Inflammatory Agents; D007641:Keratolytic Agents; D017255:Acitretin; D008775:Methylprednisolone