Abstract
Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics.
Highlights
Acute Generalized Exanthematous Pustulosis (AGEP) is a rare dermatopathy, with an incidence of 1 - 5 cases/million/year, characterized by acute and extensive emergence of sterile, non-follicular pustules on an erythematous basis
Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor
The clinical picture of AGEP may occur with persistent high fever and could be confused with systemic infections, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be treated by stopping the use of the causative drug
Summary
Acute Generalized Exanthematous Pustulosis (AGEP) is a rare dermatopathy, with an incidence of 1 - 5 cases/million/year, characterized by acute and extensive emergence of sterile, non-follicular pustules on an erythematous basis. Because it is accompanied by fever and leukocytosis [1] [2], mainly eosinophilia, the differential diagnosis of possible systemic diseases is important in order to avoid inappropriate treatment [3]. The resolution of the disease occurs between 4 and 15 days after the suspension of the causative drug, followed by scaling of the affected areas [4] [6] It is a rare disease, AGEP is a differential diagnosis with many dermatopathies and can be managed and resolved after the correct diagnosis. The following case report of AGEP occurred in Hospital de Clínicas Porto Alegre (HCPA), a public-private hospital linked to the educational institution Universidade Federal do Rio Grande do Sul (UFRGS), and aims to share the evolution of this experience to be reminded in similar situations
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