Acute generalized exanthematous pustulosis following use of ticlopidine.

Abstract

S ir, Ticlopidine is a platelet aggregation inhibitor widely used for secondary prevention of cerebrovascular accidents in patients predisposed to thrombosis. In addition to haematological side‐effects such as purpura and ecchymosis, bone marrow aplasia, and jaundice and cholestatic hepatitis, this drug may induce numerous cutaneous adverse drug reactions: pruritus, urticaria, exanthemata, hyperhidrosis, lupus erythematosus and vasculitis; 1 to the best of our knowledge, acute generalized exanthematous pustulosis (AGEP) following use of ticlopidine has not previously been reported. A 66‐year‐old woman, with a previous history of ischaemic heart disease, started oral ticlopidine (Tiklid, Sanofi Winthrop Industrie, Ambares, France) 250 mg daily, to prevent thrombosis, in March 1998. She was on no other medication, and there was no personal or family history of psoriasis. After 3 weeks, she was referred to our department with an acute, febrile (39 °C), pruritic rash. This began on the trunk and subsequently spread to the extremities; the face, palms and soles were spared and there was no mucosal involvement. Examination showed several hundred superficial, small (1–3 mm diameter), non‐follicular pustules on an erythematous base ( Fig. 1), with maceration at the axillae and groins. Laboratory findings revealed leucocytosis (white cell count 29·4 × 109/L) with a polymorphonuclear count of 21·1 × 109/L; the erythrocyte sedimentation rate was 43 mm in the first hour. Blood culture was sterile, and negative results were obtained in fungal and bacterial cultures from the pustules, and serological tests for cytomegalovirus, Epstein–Barr virus, parvovirus B19 and Coxsackie virus. Skin biopsy demonstrated subcorneal pustules with neutrophils and a perivascular inflammatory cell infiltrate in the papillary dermis.