Phloroglucinol-induced acute generalized exanthematous pustulosis: Unveils an uncommon culprit

Abstract

Acute generalized exanthematous pustulosis (AGEP) is an uncommon and potentially life-threatening skin reaction primarily triggered by medications, notably antibiotics. Herein, we present a rare case of AGEP induced by phloroglucinol, a drug not commonly associated with AGEP, with a short literature review. A previously healthy 31-year-old woman exhibited fever and a pruritic widespread rash characterized by diffuse erythema interspersed with pustules, manifesting five days following oral phloroglucinol intake. Neutrophilic leukocytosis was evident upon blood analysis. Microbiological assessment confirmed the pustules to be sterile. Histopathological examination unveiled multifocal intra-epidermal pustules, exoserosis, and a polymorphic dermal infiltrate primarily comprising neutrophils and eosinophils. Diagnosis of phloroglucinol-induced AGEP was established, with an intrinsic imputability score of I4 (S3 C3) as per the updated criteria proposed by Begaud et al. Subsequent cessation of the offending drug led to marked improvement in the patient's condition. This case underscores the importance of considering less recognized culprits, such as phloroglucinol, in the etiology of AGEP, thereby broadening the spectrum of drugs implicated in this severe dermatological reaction. Early recognition and prompt withdrawal of the offending agent remain pivotal in mitigating AGEP-associated morbidity and mortality.