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Codeine-induced acute generalized exanthematous pustulosis without IL36RN mutations.

Zohra Chadli1, Chayma Ladhari1, Emna Kerkeni1

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Summary

Acute generalized exanthematous pustulosis (AGEP) can be triggered by codeine, even without IL-36RN gene mutations. This highlights that IL-36RN gene mutations are not always required for drug-induced AGEP, particularly in psoriasis patients.

Keywords:
AGEPIL36RN mutationscodeinegeneticspsoriasis

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Area of Science:

  • Dermatology
  • Genetics
  • Pharmacology

Background:

  • Recent research suggests a link between IL-36RN gene mutations and pustular generalized conditions.
  • Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse drug reaction.
  • Codeine has been rarely associated with AGEP, with only one reported case in an IL-36RN mutation carrier.

Observation:

  • This report details an unusual case of codeine-induced AGEP in a patient with a history of psoriasis.
  • The diagnosis was confirmed through an oral provocation test.
  • The patient did not have an IL-36RN gene mutation, challenging previous assumptions.

Findings:

  • The IL-36RN gene mutation is not a prerequisite for developing drug-induced AGEP.
  • Codeine can induce AGEP in individuals without this specific genetic mutation.
  • Psoriasis history may be a relevant factor in susceptibility to codeine-induced AGEP.

Implications:

  • Clinicians should consider codeine as a potential trigger for AGEP, especially in patients with a history of psoriasis.
  • The findings suggest that the role of IL-36RN mutations in drug-induced AGEP may be less constant than previously thought.
  • Further research is necessary to fully elucidate the complex relationship between drug-induced AGEP and IL-36RN gene mutations.