Acute generalized exanthematous pustulosis induced by dexamethasone injection

Area of Science:

• Dermatology
• Clinical Pharmacology
• Pathology

Background:

• Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction typically drug-induced.
• Corticosteroids are generally considered safe for dermatological conditions, with limited reports of severe cutaneous reactions.

Observation:

• A 52-year-old woman presented with a sudden onset of widespread sterile pustules on her trunk and extremities.
• The eruption appeared two days post-subcutaneous injection of dexamethasone solution.
• Skin biopsy confirmed subcorneal pustules with neutrophils and dermal inflammation, excluding vasculitis.

Findings:

• Patch testing with dexamethasone solution elicited a positive pustular reaction, consistent with the original eruption.
• Histological examination of the induced pustule mirrored the initial skin lesions.
• This case represents, to our knowledge, the first reported instance of AGEP attributed to corticosteroid administration.

Implications:

• Highlights the potential for corticosteroids, including dexamethasone, to induce rare but severe skin reactions like AGEP.
• Emphasizes the importance of considering drug-induced reactions in the differential diagnosis of pustular eruptions.
• Suggests the need for vigilance and further investigation into the mechanisms of corticosteroid-induced hypersensitivity.