A 35-year-old man, a known hypertensive, with fever and cough, was admitted to the hospital for pneumonia. He developed a widespread nonfollicular pustular eruption on an erythematous base in the folds after receiving antibiotics for his condition. The lesions started on face. He received a cephalosporin (cefuroxime), a macrolide (azithromycin) and a quinolone (levofloxacin) for his pneumonia. Moreover, he was taking amlodipine on a regular basis before his admission for his hypertension.
His blood analysis revealed neutrophilic leucocytosis and mild eosinophilia with no internal organ involvement. The cultures were negative. The biopsy was compatible with pustular psoriasis, and his subsequent patch test was positive for cefuroxime and negative for azithromycin. How can you work out the etiology of this skin lesion?
You can follow this plan...
1. (Initial clinical impression): Acute generalized exanthematous pustulosis.
2. (Differential diagnoses): Pustular psoriasis, drug hypersensitivity syndrome and folliculitis.
3. (Analysis of drug exposure).
4. (Analysis of literature): AGEP is associated with both cefuroxime and azithromycin.
5. (Analysis of laboratory results): Neutrophilia, mild eosinophilia, no internal organ involvement, histopathology compatible with a pustular psoriasis and a positive patch test for cefuroxime.
6. (Prioritization of diagnoses): Cefuroxime-induced AGEP remained highly probable; pustular psoriasis possible, azithromycin-induced AGEP unlikely and drug hypersensitivity syndrome and folliculitis are almost excluded.
Read the full review article here...
His blood analysis revealed neutrophilic leucocytosis and mild eosinophilia with no internal organ involvement. The cultures were negative. The biopsy was compatible with pustular psoriasis, and his subsequent patch test was positive for cefuroxime and negative for azithromycin. How can you work out the etiology of this skin lesion?
You can follow this plan...
1. (Initial clinical impression): Acute generalized exanthematous pustulosis.
2. (Differential diagnoses): Pustular psoriasis, drug hypersensitivity syndrome and folliculitis.
3. (Analysis of drug exposure).
4. (Analysis of literature): AGEP is associated with both cefuroxime and azithromycin.
5. (Analysis of laboratory results): Neutrophilia, mild eosinophilia, no internal organ involvement, histopathology compatible with a pustular psoriasis and a positive patch test for cefuroxime.
6. (Prioritization of diagnoses): Cefuroxime-induced AGEP remained highly probable; pustular psoriasis possible, azithromycin-induced AGEP unlikely and drug hypersensitivity syndrome and folliculitis are almost excluded.
Read the full review article here...
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