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Life-Threatening Atypical Case of Acute Generalized Exanthematous Pustulosis

Azadeh Tajmir-Riahi1, Petra Wörl, Thomas Harrer

  • 1Departmens of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.

International Archives of Allergy and Immunology
|October 25, 2017
PubMed

Insights

Acute generalized exanthematous pustulosis (AGEP) is a severe skin reaction to antibiotics. This case highlights a rare, severe AGEP presentation in a young, healthy male, leading to critical illness.

Area of Science:

  • Dermatology
  • Pharmacology
  • Infectious Diseases

Background:

  • Antibiotics can cause severe cutaneous adverse reactions, including acute generalized exanthematous pustulosis (AGEP).
  • AGEP is typically non-life-threatening with minimal systemic involvement.
  • Good prognosis is generally expected for AGEP, except in vulnerable populations.

Observation:

  • A young, healthy male developed AGEP after treatment with five different antibiotics.
  • Initial symptoms were atypical for AGEP, rapidly progressing to critical cardiorespiratory compromise.
  • The patient developed systemic inflammatory response syndrome (SIRS) and required intensive care.

Findings:

  • The severe AGEP presentation was linked to multiple antibiotic exposures.
  • Type IV hypersensitivity reaction to antibiotics is suspected.
  • Secondary infections with Enterococcus faecium and Staphylococcus aureus were identified.
  • Underlying periodontitis may have exacerbated the condition.

Implications:

  • This case underscores the potential for severe AGEP presentations even in young, healthy individuals.
  • Early recognition and management of atypical AGEP are crucial.
  • The interplay between antibiotic allergy, secondary infections, and underlying conditions can lead to severe outcomes.
Keywords:
Acute generalized exanthematous pustulosisDrug eruptionIntensive care unitSystemic antibioticsSystemic inflammatory response syndromeSystemic involvement

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