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Terbinafine-induced acute generalized exanthematous pustulosis (AGEP) responsive to high dose intravenous

Omar A Ibrahimi1, Nilanthi Gunawardane, Alireza Sepehr

  • 1Harvard Medical School, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Dermatology Online Journal
|November 26, 2009
PubMed

Insights

Acute generalized exanthematous pustulosis (AGEP), a drug reaction, can be triggered by terbinafine. This case showed AGEP resistant to oral steroids but improved with high-dose intravenous steroids.

Area of Science:

  • Dermatology
  • Pharmacology

Background:

  • Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse drug reaction.
  • Terbinafine, an allylamine antifungal, is frequently implicated in AGEP.
  • Management of AGEP often involves corticosteroids.

Observation:

  • A patient presented with terbinafine-induced AGEP.
  • The eruption was unresponsive to standard oral corticosteroid therapy.
  • High-dose intravenous corticosteroid administration was initiated.

Findings:

  • The patient's AGEP resolved following high-dose intravenous corticosteroid treatment.
  • This suggests a potential treatment pathway for refractory cases.
  • Intravenous corticosteroids may be more effective than oral for severe terbinafine-induced AGEP.

Implications:

  • This case highlights the importance of considering intravenous corticosteroids for severe or refractory AGEP.
  • It underscores the significant potential for terbinafine to induce AGEP.
  • Further research into optimal management strategies for drug-induced pustular eruptions is warranted.

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