title: Ritodrine-induced pustular eruptions distinctly resembling impetigo herpetiformis.
abstract: A 27-year-old nulligravida woman without a history of dermatosis was hospitalized for threatened preterm labor at 29 weeks' gestation; therefore, continuous infusion of ritodrine hydrochloride was started. At 31 weeks' gestation, erythematous plaques appeared and spread over the body surface; therefore, a topical steroid preparation was applied. At 32 weeks' gestation, the eruptions developed into irregular annular areas of erythema with multiple pustules accompanied by severe itching, and oral prednisolone treatment was started. Bacterial cultures of the pustules were negative, and a crural cutaneous biopsy revealed Kogoj's spongiform pustules. Based on the clinicopathological findings, the most likely diagnosis was impetigo herpetiformis, which causes cutaneous symptoms closely resembling pustular psoriasis in pregnant females without a history of psoriasis. To rule out ritodrine-induced pustular eruptions, the ritodrine infusion was stopped and treatment with an MgSO(4) preparation was started at 33 weeks' 3 days' gestation; however, the uterine contractions could not be suppressed. Because of the patient's highly edematous, severely painful feet, a cesarean section was performed the same day. Within several days of delivery, the eruptions began to resolve, and no recurrence was observed after treatment with oral prednisolone was stopped 31 days after delivery. On the basis of a positive patch test for ritodrine, we diagnosed pustular drug eruptions caused by ritodrine hydrochloride. Although ritodrine-induced pathognomonic cutaneous eruptions are rare, we would like to emphasize that ritodrine can cause drug-induced pustular eruptions distinctly resembling life-threatening impetigo herpetiformis.
authors: Department of Obstetrics and Gynecology, Tokyo Rinkai Hospital, Japan. kuwa@nms.ac.jp
authors: Yoshimitsu
authors: Y
authors: Kuwabara
authors: Atsuki
authors: A
authors: Sato
authors: Hiroko
authors: H
authors: Abe
authors: Sumino
authors: S
authors: Abe
authors: Naoki
authors: N
authors: Kawai
authors: Toshiyuki
authors: T
authors: Takeshita
mesh_terms: D000033:Abortion, Threatened / Q000517:prevention & control; D000328:Adult; D002585:Cesarean Section; D003874:Dermatitis Herpetiformis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D003875:Drug Eruptions / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007169:Impetigo; D010328:Patch Tests; D011247:Pregnancy; D011248:Pregnancy Complications; D012312:Ritodrine / Q000009:adverse effects*; D012867:Skin / Q000473:pathology*; D015149:Tocolytic Agents / Q000009:adverse effects*
chemical_list: D015149:Tocolytic Agents; D012312:Ritodrine