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Updated: Jun 12, 2025

Granulocyte-dependent Autoantibody-induced Skin Blistering

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Piperacillin-Tazobactam-Induced Generalized Exanthematous Pustulosis.

Sudeep Chapagain¹, Prabina Basnet¹, Surendra Khanal¹

¹Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA.

|June 10, 2025

Summary

Acute generalized exanthematous pustulosis (AGEP), a rare antibiotic reaction, presents with pustules and erythema. This case highlights piperacillin-tazobactam as a trigger, with symptoms resolving after drug cessation.

Keywords:

acute generalized exanthematous pustulosis beta-lactam beta-lactam antibiotics cutaneous drug reaction fever piperacillin-tazobactam

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Area of Science:

Dermatology
Pharmacology

Background:

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse reaction.
Antibiotics, particularly beta-lactams, are the most common causative agents.
AGEP is characterized by widespread sterile pustules on an erythematous background.

Observation:

A 58-year-old female developed AGEP following piperacillin-tazobactam administration.
Clinical presentation included rapid onset of sterile pustules, swelling, and erythema.
Histopathology confirmed neutrophilic pustules and eosinophilic infiltration.

Findings:

Piperacillin-tazobactam was identified as the likely trigger for AGEP.
Discontinuation of the antibiotic led to symptom resolution.
Skin lesions resolved via desquamation within three days of drug cessation.

Implications:

This case underscores the importance of recognizing AGEP in patients exposed to piperacillin-tazobactam.
Prompt diagnosis and withdrawal of the offending agent are crucial for managing AGEP.
Understanding drug-induced AGEP aids in preventing severe cutaneous reactions.