Hydroxychloroquine-induced acute generalized exanthematous pustulosis with HLA-typing

Area of Science:

• Pharmacogenomics
• Dermatology
• Immunology

Background:

• Acute generalized exanthematous pustulosis (AGEP) is a rare but severe cutaneous adverse drug reaction.
• Hydroxychloroquine (HCQ) is an antimalarial and antirheumatic drug that has been associated with AGEP.
• Pharmacogenomic studies suggest a genetic predisposition to AGEP, particularly involving Human Leukocyte Antigen (HLA) genes.

Observation:

• This case report details a 36-year-old female who developed AGEP after initiating HCQ therapy.
• The patient underwent HLA-typing to investigate the genetic basis of her reaction.
• Specific HLA alleles, including HLA-B*58:01, HLA-C*08:01, and HLA-A*02:06, were identified in the patient.

Findings:

• The identified HLA alleles may confer susceptibility to HCQ-induced AGEP.
• This case provides further evidence for the association between specific HLA genotypes and drug-induced AGEP.
• The findings highlight the importance of individual genetic profiles in predicting adverse drug reactions.

Implications:

• HLA genotyping prior to HCQ prescription could potentially identify at-risk individuals.
• Implementing pharmacogenomic screening may help prevent severe cutaneous adverse drug reactions like AGEP.
• This approach could lead to more personalized and safer drug prescribing strategies, with potential pharmacoeconomic benefits.