Acute generalized exanthematous pustulosis

Background

• T-cell mediated rash with systemic features
• >90% of cases attributable to a medication (usually an antibiotic)
• Mortality rate of ~5%

Clinical Features

• Onset 1-5 days after starting causative medication
• Rash:
  • Large areas of edematous erythema with numerous small, non-follicular pustules
  • Predominantly affects main body folds and upper trunk, but can involve face
  • NO mucous membrane involvement (in contrast to SJS/TEN)
• Systemic findings:
  • Fever
  • Leukocytosis, specifically neutrophilia
  • +/- Facial swelling
  • +/- Hepatitis
  • +/- Eosinophilia

Differential Diagnosis

• Erythema Multiforme
• Stevens-Johnson syndrome and toxic epidermal necrolysis
• Staphylococcal scalded skin syndrome
• Erythroderma
• Toxic Shock Syndrome
• Drug rash
• DRESS syndrome

Evaluation

• Clinical diagnosis
• CBC
• BMP
• LFTs

Management

• Stop inciting agent
• IVF- treat similar to fluid resuscitation in burns
• Wound care, infection control

Disposition

• Admit

See Also

• Stevens-Johnson syndrome and toxic epidermal necrolysis
• DRESS syndrome