title: Probable fenofibrate-induced acute generalized exanthematous pustulosis.
abstract: OBJECTIVE
  The case of a patient who experienced a severe adverse reaction requiring emergency treatment after a single dose of fenofibrate is described.
  
  
  CONCLUSIONS
  A 58-year-old woman with type 1 diabetes was hospitalized for treatment of an extensive blistering rash on the buttocks and trunk accompanied by fever, hypotension, tachycardia, neutrophilia, impaired renal function, and liver enzyme abnormalities. She reported that two days previously she had developed fever and vomiting four hours after taking her first dose of fenofibrate (145 mg). The patient required vasopressor support and was initially treated with broad-spectrum antibiotics for 3 days and a course of immune globulin. On hospital day 4, histopathology returned results consistent with acute generalized exanthematous pustulosis (AGEP), and the patient was subsequently treated with topical steroids. Gradual resolution of AGEP was noted at the time of her discharge from the hospital on day 7 and at one-week follow-up. Analysis of the case using the adverse drug reaction probability scale of Naranjo et al. yielded a score of 5, indicating a probable association between fenofibrate use and AGEP development. AGEP is a predominantly drug-induced condition but is not typically associated with fenofibrate use. Cutaneous eruptions in AGEP are often accompanied by systemic symptoms (e.g., fever, leukocytosis), and the disorder can also be associated with impaired creatinine clearance and elevated aminotransaminase levels.
  
  
  CONCLUSIONS
  A woman with type 1 diabetes developed AGEP after taking a single dose of fenofibrate. Her cutaneous symptoms began to resolve within days of discontinuation of fenofibrate use.
authors.affiliation: Anna E. Power is a medical student, Monash University, Melbourne, Australia, and Summer Vacation Scholar, Centre of Cardiovascular Research & Education (CCRE) in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre, Melbourne. Linda V. Graudins, B.Pharm., Dip.HospPharm., PGrad.Clinepid., FSHP, is Senior Pharmacist, Pharmacy Department, Alfred Health, Melbourne. Catriona A. McLean, B.Sc., M.B.B.S., FRACPA, M.D., FFSc, is Pathologist, Department of Anatomical Pathology, Alfred Hospital, Melbourne. Ingrid Hopper, M.B.B.S., B.Med.SC., FRACP, is Clinical Pharmacologist, Alfred Health, and National Health and Medical Research Council Postgraduate Scholar, CCRE in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre.
authors.forename: Anna E
authors.initials: AE
authors.lastname: Power
authors.affiliation: Anna E. Power is a medical student, Monash University, Melbourne, Australia, and Summer Vacation Scholar, Centre of Cardiovascular Research & Education (CCRE) in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre, Melbourne. Linda V. Graudins, B.Pharm., Dip.HospPharm., PGrad.Clinepid., FSHP, is Senior Pharmacist, Pharmacy Department, Alfred Health, Melbourne. Catriona A. McLean, B.Sc., M.B.B.S., FRACPA, M.D., FFSc, is Pathologist, Department of Anatomical Pathology, Alfred Hospital, Melbourne. Ingrid Hopper, M.B.B.S., B.Med.SC., FRACP, is Clinical Pharmacologist, Alfred Health, and National Health and Medical Research Council Postgraduate Scholar, CCRE in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre.
authors.forename: Linda V
authors.initials: LV
authors.lastname: Graudins
authors.affiliation: Anna E. Power is a medical student, Monash University, Melbourne, Australia, and Summer Vacation Scholar, Centre of Cardiovascular Research & Education (CCRE) in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre, Melbourne. Linda V. Graudins, B.Pharm., Dip.HospPharm., PGrad.Clinepid., FSHP, is Senior Pharmacist, Pharmacy Department, Alfred Health, Melbourne. Catriona A. McLean, B.Sc., M.B.B.S., FRACPA, M.D., FFSc, is Pathologist, Department of Anatomical Pathology, Alfred Hospital, Melbourne. Ingrid Hopper, M.B.B.S., B.Med.SC., FRACP, is Clinical Pharmacologist, Alfred Health, and National Health and Medical Research Council Postgraduate Scholar, CCRE in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre.
authors.forename: Catriona A
authors.initials: CA
authors.lastname: McLean
authors.affiliation: Anna E. Power is a medical student, Monash University, Melbourne, Australia, and Summer Vacation Scholar, Centre of Cardiovascular Research & Education (CCRE) in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre, Melbourne. Linda V. Graudins, B.Pharm., Dip.HospPharm., PGrad.Clinepid., FSHP, is Senior Pharmacist, Pharmacy Department, Alfred Health, Melbourne. Catriona A. McLean, B.Sc., M.B.B.S., FRACPA, M.D., FFSc, is Pathologist, Department of Anatomical Pathology, Alfred Hospital, Melbourne. Ingrid Hopper, M.B.B.S., B.Med.SC., FRACP, is Clinical Pharmacologist, Alfred Health, and National Health and Medical Research Council Postgraduate Scholar, CCRE in Therapeutics, School of Public Health and Preventive Medicine, Alfred Centre. ingrid.hopper@monash.edu.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Hopper
mesh_terms: D056150:Acute Generalized Exanthematous Pustulosis / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D005260:Female; D011345:Fenofibrate / Q000008:administration & dosage / Q000009:adverse effects*; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D005938:Glucocorticoids; D000960:Hypolipidemic Agents; D011345:Fenofibrate