Acute generalised exanthematous pustulosis associated with shock. Issue 10 (30th October 2020)

• Record Type: Journal Article
• Authors: Costa, Philippos Apolinario; Costa, Bruna Menon Loureiro Apolinario; Milikowski, Clara; St Onge, Joan E
• Is Part Of: BMJ case reports. Volume 13:Issue 10(2020)
• Publication Date: 2020-10-30
• Subjects: drugs and medicines -- skin -- unwanted effects / adverse reactions; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-235846
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 23-year-old man with a history of end-stage renal disease was admitted to the hospital due to fever and shock, which occurred during his dialysis. One week prior, he developed an erythematous rash on his chest, face and back, associated with generalised eruption of pustules. In hospital, his status did not improve with norepinephrine and empirical broad-spectrum antibiotics. Following this, methylprednisolone was administered with remarkable improvement. Cultures revealed no infectious aetiology. Based on the morphology of the rash and a compatible skin biopsy, the diagnosis of acute generalised exanthematous pustulosis (AGEP) was established and considered the cause of his shock. The causative agent of his AGEP remained unknown. AGEP is a rare condition, most frequently associated with drug exposure. The removal of the offending agent is the treatment of choice. It can be complicated by shock in rare cases. In that scenario, systemic corticosteroids seem to improve outcomes greatly.