Acute Generalised Exanthematous Pustulosis

Diagnosis: Acute Generalised Exanthematous Pustulosis

Numerous, small and non-follicular pustules arise on a widespread oedematous erythema (due to ceftriaxone).

Clinical Presentation

Numerous, small and non-follicular pustules arise on a widespread oedematous erythema (due to ceftriaxone).

Clinical History

Submitted by Alaa Saad. Originally posted September 13, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Pustular psoriasis (generalized) • Drug reaction with eosinophilia and systemic symptoms (DRESS) • Toxic epidermal necrolysis • Subcorneal pustular dermatosis (Sneddon-Wilkinson) • Staphylococcal scalded skin syndrome

Key Learnings

• Acute Generalized Exanthematous Pustulosis — severe cutaneous drug reaction • Rapid onset (usually <48 hours after drug exposure) of widespread non-follicular sterile pustules • High fever and neutrophilia • Most common culprits: antibiotics (beta-lactams, macrolides), calcium channel blockers, antimalarials • Self-limited: resolves within 1-2 weeks of drug withdrawal with characteristic desquamation • Mortality <5% (better prognosis than SJS/TEN) • Must distinguish from generalized pustular psoriasis — often challenging

Tags: acute, generalised, exanthematous, pustulosis, alaa saad