Diltiazem-Induced Acute Generalized Exanthematous Pustulosis: a Case Report and Review of the Literature (original) (raw)
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Acute Generalized Exanthematous Pustulosis Caused by Diltiazem
Annals of Dermatology, 2011
Acute generalized exanthematous pustulosis is clinically characterized by fever, pruritus and an acute pustular eruption. It can be described as having an abrupt onset and then spontaneous resolution occurs shortly after the start of symptoms, and there is usually only a single episode. Most cases have been triggered by the ingestion of drugs. Diltiazem hydrochloride is a calcium channel blocker that is commonly used for treating hypertension and angina. This drug was found to be the responsible agent in our current patient. There have been 9 such case reports in the English medical literature, yet this is the first such report in the Korean medical literature. We present the case of a 51-year-old male who experienced an acute generalized exanthematous pustulosis due to diltiazem hydrochloride and we review the relevant literature. (Ann Dermatol 23(1) 108∼110, 2011
Journal of Clinical Medicine
Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard devia...
Acute generalized exanthematous pustulosis due to diltiazem: confirmation by patch testing
British Journal of Dermatology, 1997
Tetrazepam is a benzodiazepine that is widely used in Spain as a muscle relaxant, with occasional cutaneous side effects. We report a patient who developed a generalized pruriginous cutaneous reaction compatible with acute generalized exanthematous pustulosis (AGEP) due to tetrazepam. Patch tests with bromazepam, diazepam, and tetrazepam were negative at 48 and 72 hours; however, the tetrazepam patch showed a positive reaction at 10 days. Immunohistochemical studies revealed a mononuclear infi ltrate composed of CD4 + and CD8 + T lymphocytes. Analysis of interleukin (IL) 8 expression by quantitative polymerase chain reaction revealed increased IL-8 mRNA levels in patch test-positive skin. Lymphoblast transformation test (LTT) was positive with tetrazepam but not with diazepam. Positive patch test and LTT suggested that tetrazepam-specifi c lymphocytes might be responsible for a T cell-mediated reaction. These results support previous data suggesting an important role for IL-8 and drug-specifi c T cells in the pathogenesis of AGEP and imply that the reaction was specifi c to tetrazepam with no cross-reactivity to other benzodiazepines.
Acute generalized exanthematous pustulosis (AGEP): a literature review
Scripta Scientifica Medica, 2013
Acute generalized exanthematous pustulosis (AGEP) is a rare drug-induced pustular cutaneous reaction. The clinical course is characteristic with a sudden onset of multiple sterile pustules on an erythemantous base with fever and neutrophilia, followed by a spontaneous resolution within two weeks. Drug-specific T cells play the main role in the pathogenesis, but the exact cytokine cascade and genetic background are yet to be elucidated. Timely and exact recognition is important in order to prevent confusion with infections and psoriasis and hence institution of unnecessary and wrong treatments. The diagnosis may be confirmed by typical history, identification of a culprit drug, histopathology and patch testing. The purpose of this review is to present the current knowledge on AGEP and its association with various drugs in the context of a drug allergic reaction.
Acute generalized exanthematous pustulosis (AGEP) - A clinical reaction pattern
Journal of Cutaneous Pathology, 2001
Background: A wide range of diseases or reactions can cause pustu-Alexis Sidoroff 1 , Sima Halevy 2 , lar eruptions of the skin. In this spectrum there seems to be a subgroup Jan Nico Bouwes Bavinck 3 , with characteristic clinical features and a typical course which is most-Loïc Vaillant 4 and ly caused by drugs for which the term acute generalized exanthema-Jean-Claude Roujeau 5 tous pustulosis (AGEP) has been established.
cutaneous adverse drug reactions-re l e v a n t aspects to diagnosis and treatment-Part II *
2004
Severe cutaneous adverse drug reactions generally require hospitalization, sometimes in intensive care or burns units, for observation of the vital signs and the visceral function. The objective was to describe these reac tions in order to facilitate recognition and treatment. This group of drug reactions includes drug hypersensitivity syndrome (DHS), acute generalized exanthematous pustulosis (AGEP), anticoagulant-induced skin necrosis, smallvessel vasculitis (SVV), propylthiouracil hypersensitivity vasculitis and serum sickness disease. DHS has been most relevant due to universal prescription of aromatic anticonvulsant drugs and dapsone use in the treatment of some diseases such as acne and leprosy. AGEP is mostly induced by b-lactam related drugs and presents similar clinical characteristics as generalized pustular psoriasis, thus these must be differentiated. SVV can present an occult sys temic illness, with impairment of relevant internal organs, such as kidneys, lungs and hema...
Lornoxicam-induced acute generalized exanthematous pustulosis
International journal of dermatology, 2016
Lornoxicam-induced acute generalized exanthematous pustulosis Editor, Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous reaction characterized by the sudden onset of small and sterile pustules on erythematous underlying skin. Its diagnosis is more difficult if the patient has a history of psoriasis. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been reported to induce AGEP. However, AGEP with lornoxicam has not been reported previously. Herein, we present the first case of AGEP in a patient with a history of psoriasis. A 39-year-old woman with a 5-year history of psoriasis was treated with acitretin. The patient presented disseminated pustules on the face and trunk. She received lornoxicam for back pain. Two days later, she developed a rapidly extensive erythematous skin eruption without fever. The skin rash extended within 24 hours from the face to involve the skin of the entire body. The patient decided to withdraw the lornoxicam and thus did not use any medication other than acitretin. At the time of admission, physical examination revealed generalized erythroderma patches with pinpoint pustules on the face, trunk, and limbs (Fig. 1). The patient was afebrile and in good general health. Laboratory analyses showed normal leukocytes (8.6 9 10 9 /l) with a 72% (6.2 9 10 9 /l) neutrophil and 3.1% (0.3 9 10 9 /l) eosinophil count. C-reactive protein was normal (<8 mg/l). The results of renal and liver function tests were within normal ranges. There was no evidence of Staphylococcus aureus in the pustules. Viral serologies for human herpesvirus 6, cytomegalovirus, and Epstein-Barr virus (EBV) were negative. Histopathology of a skin biopsy revealed irregular acanthosis, spongiosis, orthokeratosis associated with neutrophil cells, and a large number of non-follicular pustules lying under the corneal layer with rare necrotic keratinocytes (Fig. 2). These histopathological findings were consistent with the diagnosis of AGEP. Based on clinical and histopathological findings, a diagnosis of lornoxicam-induced AGEP was suspected. The patient was treated with acetaminophen for her back pain and topical corticosteroid therapy was started.