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A 61 year-old man developed an acute generalized pustular rash. It was a bit red and bumpy at first, and blossomed over 3 days. He presented to the Emergency Room with this rash. He had been taking Lipitor for 7 years. On admission, he had a low grade fever (100.8F) and reported that he felt mildly fatigued. 7 days prior to presentation, he was working in his garage and scraped his leg on the edge of a cardboard box. The area was tender, so he went to a “rapid-clinic” in a drug store, where they gave him a course of Bactrim. His rash started 3 days after the initiation of Bactrim. He has no personal history of psoriasis. Current lab work demonstrates neutrophilia. No oral or genital involvement.
What is your diagnosis?
Diagnosis:
Acute Generalized Exanthematous Pustulosis (AGEP)
This is a relatively rare, medication induced explosive pustular eruption. The condition must be differentiated from both pustular psoriasis and Steven-Johnson’s syndrome. Patient may complain of a fever, fatigue, and/or abdominal pain (hepatic involvement). The pustular rash usually occurs shortly (days) after the initiation of the medication. Although any medication can cause the reaction, the most common medications are: antibiotics, oral antifungals, calcium channel blockers, and antimalarials.
Treatment involves removing the offending medication and the rash will resolve in 5-10 days. Also, employ supportive measures for puritus, discomfort and hepatic involvement, if present. Some reports indicate a mortality rate of 5% if the medication is not discontinued.
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