scholarly journals A Case of Ceftriaxone-Induced Acute Generalized Exanthematous Pustulosis/Generalized Pustular Psoriasis Overlap

2018 ◽  
Vol 10 (1) ◽  
pp. 69-75 ◽  
Author(s):  
Jianfeng Zheng ◽  
Yunlu Gao ◽  
Xuemei Yi ◽  
Yangfeng Ding
Keyword(s):  
Pustular Psoriasis ◽  
Whole Body ◽  
Complete Regression ◽  
Clinical Form ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Plaque Type ◽  
Generalized Pustular Psoriasis ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Missense Substitution

Acute generalized exanthematous pustulosis, characterized by subcorneal or superficial intraepidermal pustules, is induced by drugs in more than 90% of cases. Psoriasis is an autoimmune disease triggered by different conditions in genetically susceptible people. Generalized pustular psoriasis is an acute and severe clinical form of psoriasis, which usually occurs in patients with psoriasis undergoing aggravating factors. In this report the authors have reported a 40-year-old male patient with primary syphilis who developed generalized pustular dermatosis after the use of ceftriaxone. On the third day after ceftriaxone treatment, complete regression of the syphilis lesions was reached. While on the sixth day, erythematous pustular lesions accompanied with fever were observed on the whole body. A personal history of psoriasis and histopathological findings with psoriasiform changes and subcorneal pustule favored the diagnosis. After discontinuation of ceftriaxone, the patient’s condition slowly improved until he had plaque-type psoriasis 3 weeks later. A heterozygous c.115 + 6T>C missense substitution of IL36RN related to the pathogenesis of acute generalized exanthematous pustulosis/generalized pustular psoriasis was identified.

scholarly journals Steroid-resistant Acute Generalized Exanthematous Pustulosis Mimicking Generalized Pustular Psoriasis Successfully Treated by Methotrexate

2021 ◽  
Vol 79 (3) ◽  
pp. 257-260
Author(s):  
Khairuddin Djawad
Keyword(s):  
Inflammatory Cell ◽  
Pustular Psoriasis ◽  
Clinical Form ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Steroid Resistant ◽  
Pustular Eruption ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Generalized Pustular Psoriasis ◽  
Exanthematous Pustulosis

Acute generalized exanthematous pustulosis is a rare drug-induced eruption that is characterized by sterile non-follicular pustules arising on an often edematous diffuse erythematous background. Generalized pustular psoriasis is an acute and severe clinical form of psoriasis presenting as pustular eruption with erythematous base. Differentiating both diseases is often challenging because of their clinical and histopathological similarities. A 62-year-old woman presented with pustular eruption and fever three days after taking propyphenazone. Laboratory findings revealed leukocytosis and neutrophilia. Histopathological findings revealed a subcorneal spongiform pustule filled with neutrophils and perivascular inflammatory cell infiltration with neutrophils in the dermis. She was initially treated with systemic steroids, however, the lesions showed insignificant improvement. Treatment was then shifted to methotrexate which resulted in a dramatic clinical improvement.

scholarly journals Pustular Psoriasis and Acute Generalized Exanthematous Pustulosis

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1004
Author(s):  
Morgan Sussman ◽  
Anthony Napodano ◽  
Simo Huang ◽  
Abhirup Are ◽  
Sylvia Hsu ◽  
...  
Keyword(s):  
Adverse Reaction ◽  
Clinical Course ◽  
Pustular Psoriasis ◽  
Topical Steroids ◽  
Inflammatory Disorder ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Cutaneous Adverse Reaction ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Crucial Part

The similarity between pustular psoriasis (PP) and acute generalized exanthematous pustulosis (AGEP) poses problems in the diagnosis and treatment of these two conditions. Significant clinical and histopathologic overlap exists between PP and AGEP. PP is an inflammatory disorder that has numerous clinical subtypes, but all with sterile pustules composed of neutrophils. AGEP is a severe cutaneous adverse reaction that is also characterized by non-follicular sterile pustules. Clinical features that suggest a diagnosis of PP over AGEP include a history of psoriasis and the presence of scaling plaques. Histologically, eosinophilic spongiosis, vacuolar interface dermatitis, and dermal eosinophilia favor a diagnosis of AGEP over PP. Importantly, PP and AGEP vary in clinical course and treatment. PP treatment involves topical steroids, oral retinoids, and systemic immunosuppressants. Newer therapies targeting IL-36, IL-23, IL-1, and PDE-4 have been investigated. The removal of the offending agent is a crucial part of the treatment of AGEP.

scholarly journals Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab

2021 ◽  
Vol 8 ◽  
Author(s):  
Liangliang Zhang ◽  
Qiuyun Xu ◽  
Tingting Lin ◽  
Shifan Ruan ◽  
Mengting Lin ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Acute Onset ◽  
Cutaneous Lesions ◽  
Diagnostic Score ◽  
Reactive Protein ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Generalized Pustular Psoriasis ◽  
History Of ◽  
Exanthematous Pustulosis ◽  
Related Reaction

Acute generalized exanthematous pustulosis is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base. Most cases of acute generalized exanthematous pustulosis (AGEP) clear quickly with a systemic corticosteroid, but severe or recalcitrant cases may need other systemic therapies. In this case, a man in his 40 s with a history of psoriasis consulted a physician about widespread erythema, pustules, target lesions, and fever after the administration of a quadruple antituberculosis drug. Routine laboratory testing revealed elevated white blood cell count and C-reactive protein. The histopathology showed subcorneal pustules, spongiosis as well as lymphocyte and eosinophils infiltration in the dermis. The patient was diagnosed with definitive AGEP according to the diagnostic score from the EuroSCAR study. Cutaneous lesions especially pustules and erythema multiforme-like lesions on the upper arms and palms are crucial for distinguishing AGEP from Generalized pustular psoriasis. The patient was treated with secukinumab as a result of his failure to respond to topical corticosteroids and constrain of systemic steroids. Remission with secukinumab therapy was safe without increased risks of infections. This case indicates that secukinumab is a potential therapy that can rapidly improve the clinical symptoms of AGEP.

Case of generalized pustular psoriasis that might have progressed from terbinafine-induced acute generalized exanthematous pustulosis

2018 ◽  
Vol 45 (12) ◽  
pp. e328-e329 ◽  
Author(s):  
Shuichiro Yasuno ◽  
Michiya Yamaguchi ◽  
Akemi Tanaka ◽  
Kaori Umehara ◽  
Tomoko Okita ◽  
...  
Keyword(s):  
Pustular Psoriasis ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Generalized Pustular Psoriasis ◽  
Exanthematous Pustulosis

scholarly journals Generalized Pustular Psoriasis in an Adolescent Treated with Cyclosporine: A Diagnostic and Therapeutic Challenge

2019 ◽  
Vol 3 (6) ◽  
pp. 447-451
Author(s):  
Roya S. Nazarian ◽  
John Nia ◽  
Nikki Vyas ◽  
Garrett Desman ◽  
Lauren Geller
Keyword(s):  
Cyclosporine A ◽  
Pediatric Population ◽  
Treatment Options ◽  
Pustular Psoriasis ◽  
Therapeutic Challenge ◽  
Childhood Disease ◽  
Acute Generalized Exanthematous Pustulosis ◽  
Generalized Pustular Psoriasis ◽  
Proper Diagnosis ◽  
Exanthematous Pustulosis

Generalized pustular psoriasis (GPP) is rare in the pediatric population, accounting for only 0.5-0.6% of psoriasis cases in children. This presents a diagnostic and therapeutic challenge, and often requires a biopsy to differentiate GPP from similar entities such as acute generalized exanthematous pustulosis, though controversy exists regarding the histologic distinction between the two.  We describe a case of GPP in a 15-year-old male presenting with widespread pustular and bullous lesions, fever, and vital instability. The patient was diagnosed with GPP and successfully treated with cyclosporine 3mg/kg/day. He remains in remission on 25 mg acitretin daily.  We present this case to highlight available treatment options for GPP in the pediatric population, and to underscore key clinical and histologic findings to aid dermatologists in proper diagnosis and management of this rare childhood disease. 

scholarly journals Elderly-Onset Generalized Pustular Psoriasis without a Previous History of Psoriasis Vulgaris

2015 ◽  
Vol 7 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Takayuki Aizu ◽  
Akinobu Matsui ◽  
Noriko Takiyoshi ◽  
Eijiro Akasaka ◽  
Takahide Kaneko ◽  
...  
Keyword(s):  
Psoriasis Vulgaris ◽  
Clinical Course ◽  
Previous History ◽  
Neutrophil Infiltration ◽  
Skin Lesions ◽  
Pustular Psoriasis ◽  
Whole Body ◽  
Older Individuals ◽  
Generalized Pustular Psoriasis ◽  
History Of

Generalized pustular psoriasis (GPP) is characterized by sudden fever and extensive erythema with pustules and occurs in patients with or without preceding psoriasis vulgaris. We report an 83-year-old man showing irregularly shaped erythema with pustules on the trunk and extremities. He initially had no fever and came to our clinic a few days after the onset of the skin lesions because of high fever and general malaise. We found an extension and new development of erythema and pustules on the whole body. The patient also manifested night delirium. Histological examination revealed neutrophil infiltration into the upper epidermis, which formed a spongiform pustule of Kogoj. Pustular fluid cultures were negative for bacteria. We diagnosed GPP without preceding psoriasis vulgaris. Mutation analysis revealed no significant mutations in IL36RN and CARD14. Previous reports indicated that onset of GPP at the age of 83 years is definitely rare. In older individuals, general disease characteristics include an atypical clinical course, an especially slow appearance and cure, and mental disorder. Our case also revealed such characteristics. Thus, it is necessary to be aware of the clinical course and mental problems in elderly patients with GPP.

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