Abstract
Acute generalised exanthematous pustulosis (AGEP) is a rare drug-induced pustular eruption characterised by the rapid onset of superficial pinhead pustules. We discuss the case of a 27-year-old man who presented with a generalised pustular eruption on the neck, trunk and limbs. He commenced upadacitinib for the treatment of atopic dermatitis (AD) 6months before developing the rash, and the dose was increased from 15 to 30mg daily, 3months prior. His only other medication was oral terbinafine, for suspected tinea corporis, which was initiated 1month before developing the pustular eruption. Laboratory investigations showed a mildly raised CRP 25mg/L, neutrophilia 8.22 10×9/L, and a mildly raised ALT 46U/L. A skin biopsy showed subcorneal pustules and a few scattered keratinocytes. Upadacitinib and terbinafine were suspended and the pustular eruption resolved. Updacitinib was reintroduced 3weeks later as the rash was thought to be due to terbinafine and the rash recurred. He was diagnosed with AGEP secondary to upadacitinib. Upadacitinib is a selective JAK inhibitor that is increasingly used for the management of AD and clinicians should be aware that AGEP is a rare but severe adverse effect.
Published Version
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