Overview
Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse drug reaction characterized by the sudden onset of numerous sterile pustules on erythematous and edematous skin, often triggered by antibiotic use, including clindamycin, cefixime, and vancomycin 1234.Diagnosis
Clinical Presentation: Presence of numerous small, non-follicular pustules on an erythematous background, often accompanied by fever, leukocytosis, and systemic involvement 1.
Laboratory Findings: Neutrophilic leukocytosis, eosinophilia, transaminitis, and acute renal failure may be observed 1.
Skin Biopsy: Histological examination showing spongiform pustules in the dermis 1.
Differential Diagnosis: Distinguishing from sepsis, toxic epidermal necrolysis, and other pustular eruptions 14.
Drug History: Recent exposure to antibiotics, particularly beta-lactams, macrolides, clindamycin, cefixime, and vancomycin 234.Management
Discontinue Offending Agent: Immediate withdrawal of the suspected drug 134.
Systemic Corticosteroids: Initiation of systemic steroids for severe cases, often showing improvement within 48 hours 1.
Supportive Care: Management of organ dysfunction (e.g., vasopressors, dialysis, mechanical ventilation) as needed 1.
Monitoring: Close monitoring of vital signs, renal function, and skin condition 14.Special Populations
Elderly: Increased risk of severe systemic involvement mimicking septic shock 1.
Comorbidities: Presence of comorbidities like cellulitis may complicate diagnosis and management 14.Key Recommendations
Withdraw the suspected drug immediately upon suspicion of AGEP (Evidence: Strong 134).
Initiate systemic corticosteroids for severe cases to hasten resolution of skin manifestations (Evidence: Moderate 1).
Provide comprehensive supportive care addressing multi-organ dysfunction (Evidence: Moderate 1).
Thoroughly evaluate drug history, particularly recent antibiotic use, in suspected cases (Evidence: Expert opinion 234).References
1 Cravero K, Chakrala T, Shychuk A. Multisystem organ failure secondary to acute generalised exanthematous pustulosis (AGEP) with atypical presentation resembling septic shock. BMJ case reports 2022. link
2 Kumar V, Kalaiselvan V, Kumar AP, Saurabh A, Thota P, Sidhu S et al.. Cefixime-associated acute generalized exanthematous pustulosis: Rare cases in India. Indian journal of pharmacology 2018. link
3 Smeets TJ, Jessurun N, Härmark L, Kardaun SH. Clindamycin-induced acute generalised exanthematous pustulosis: five cases and a review of the literature. The Netherlands journal of medicine 2016. link
4 Mohyuddin GR, Al Asad M, Scratchko L, Khaleeq G. Acute generalized exanthematous pustulosis with multiple organ dysfunction syndrome. American journal of critical care : an official publication, American Association of Critical-Care Nurses 2013. link