Abstract
Introduction: Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks. Current report aims to present management of AGEP in our center at Singaraja Regional Hospital, Bali-Indonesia.Case: A 78 years old woman with a history of acute coronary syndrome, was reported to have a severe allergic drug reaction. Patients reported taking cefixime medication for the past 2 days because of acute bronchitis. The patient was hospitalized because of the complaint, and diffuse miliary pustules were found above the base of erythematous skin. On examination of lesions, the Nikolsky sign was positive on lesions in the back and abdomen without any tenderness. Histopathological examination was suitable for the diagnosis of acute generalized exanthema pustulosis (AGEP). Systemic intravenous corticosteroid with oral antihistamines was choosen as a primary treatment for this patient.Conclusion: Treatment is based on the removal of the causative drug, supportive care, infection prevention and use of potent topical or systemic steroids
Highlights
Acute generalized exanthematous pustulosis (AGEP) is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base and spontaneous resolution usually within two weeks
Acute generalized exanthema pustulosis (AGEP) is a severe cutaneous reaction caused by a drug allergy
An AGEP case that is thought to have been caused by beta-lactam group of antibiotics in a patient with acute coronary syndrome has been reported
Summary
Acute generalized exanthema pustulosis (AGEP) is a severe cutaneous reaction caused by a drug allergy. On complete blood tests can be found an increase in leukocytes, neutrophils and eosinophilia. Two days later after taking the drug, the patient had burning sensation on the skin accompanied by itching. One day later a reddish rash appeared and pustules arise in thighs and neck fold which quickly spread throughout the body. Evaluation of lesions showed a positive nikolsky sign on the back, abdomen, and right upper thigh areas. Blood tests obtained 60.6 k/uL leukocytes, 54.3% neutrophils and 1.79% lymphocytes. The kidney function test found an increase in creatinine 1.89 mg/dl and urea 113.0. Histopathological result taken from the right upper extremity lesions were obtained by subcorneum blister, in which there were inflammatory cells of. Laboratory tests afterward showed a significant improvement, namely a decrease in leukocyte levels to 9.58 k/uL with 7.37% neutrophils and 0.66% lymphocytes. Electrolyte examination was obtained potassium [4,1] mmol/L
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