Acute generalised exanthematous pustulosis associated with shock

Area of Science:

• Dermatology
• Nephrology

Background:

• End-stage renal disease (ESRD) patients undergoing dialysis are susceptible to various complications.
• Acute generalised exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse drug reaction.

Observation:

• A 23-year-old male with ESRD presented with fever and shock during dialysis.
• He developed a widespread pustular rash preceding his shock.
• Initial treatment with vasopressors and antibiotics was ineffective.

Findings:

• Diagnosis of AGEP was confirmed via skin biopsy and clinical presentation.
• No infectious cause was identified despite extensive cultures.
• Methylprednisolone administration led to remarkable clinical improvement.

Implications:

• AGEP can present with shock, a rare but serious complication.
• Systemic corticosteroids may be beneficial in managing AGEP-induced shock.
• Identifying the causative agent, often a drug, is crucial for AGEP management.