Fluconazole-induced acute generalized exanthematous pustulosis

Area of Science:

• Dermatology
• Pharmacology
• Pediatrics

Background:

• Acute Generalized Exanthematous Pustulosis (AGEP) is a rare, severe cutaneous adverse drug reaction with an incidence of 1-5 cases per million annually.
• AGEP presents as an acute febrile episode with widespread edematous erythema and numerous sterile pustules.
• Antifungal medications are known triggers for AGEP, with terbinafine being the most frequently implicated.

Observation:

• A 7-year-old boy developed AGEP.
• The patient had recently started oral fluconazole treatment for Tinea capitis.
• The onset of AGEP occurred shortly after initiating fluconazole therapy.

Findings:

• This case represents the fourth reported instance of AGEP associated with fluconazole use.
• The clinical presentation was consistent with the diagnostic criteria for AGEP.

Implications:

• Fluconazole should be considered a potential cause of AGEP, particularly in pediatric patients.
• Further investigation into the specific mechanisms of fluconazole-induced AGEP is warranted.
• Clinicians should maintain a high index of suspicion for AGEP in patients presenting with characteristic symptoms after antifungal drug exposure.