Probable fenofibrate-induced acute generalized exanthematous pustulosis

Area of Science:

• Pharmacology
• Dermatology
• Toxicology

Background:

• Fenofibrate is a commonly prescribed lipid-lowering agent.
• Adverse drug reactions (ADRs) can range from mild to life-threatening.
• Acute Generalized Exanthematous Pustulosis (AGEP) is a severe cutaneous adverse reaction typically drug-induced.

Observation:

• A 58-year-old woman with type 1 diabetes presented with a severe blistering rash, fever, hypotension, and elevated liver enzymes.
• Symptoms began four hours after the first dose of fenofibrate (145 mg).
• Histopathology confirmed AGEP, a condition not commonly associated with fenofibrate.

Findings:

• The patient required intensive care, including vasopressor support and broad-spectrum antibiotics.
• Discontinuation of fenofibrate and treatment with topical steroids led to gradual resolution of AGEP.
• Naranjo scale analysis indicated a probable association between fenofibrate and AGEP development.

Implications:

• This case expands the known spectrum of fenofibrate-induced adverse drug reactions.
• Highlights the importance of considering rare ADRs even with common medications.
• Emphasizes prompt recognition and management of severe cutaneous reactions to medications.