Allergy Asthma Respir Dis.  2013 Jun;1(2):176-178. 10.4168/aard.2013.1.2.176.

Acute generalized exanthematous pustulosis due to hydroxychloroquine in a rheumatoid arthritis patient

• Lim HJ
• Jung JH
• Kim MJ
• Kim JM
• Kang HR
• Song YK
• Hur JW
• Kim SH
• Kim EK

• KMID: 2261868
• DOI: http://doi.org/10.4168/aard.2013.1.2.176

Abstract

Acute generalized exanthematous pustulosis (AGEP) is characterized by acute nonfollicular sterile pustules on a background of edematous erythema. Hydroxychloroquine (HCQ), an antimalarial drug, widely used to treat rheumatic and dermatologic diseases. HCQ has been reported to be an uncommon cause of AGEP. We report a 60-year-old woman with rheumatoid arthritis requiring the use of HCQ presented fever and erythematous eruption on the trunk with sterile pustules. Leukocytosis and elevated erythrocyte sedimention rate noted on laboratory examination. On the histopathological examination of the skin biopsy specimen showed neutrophilic infiltration and scattered eosinohpils. The lesions were resolved with removal of HCQ. The clinical course was consistent with the diagnosis of AGEP associated with HCQ. We reported a case of typical AGEP associated with HCQ in a patient with Rheumatoid arthritis. The patient presented resolution from cutaneous lesions with withdrawal of culprit drug, without the need of systemic steroid.

Keyword

Acute generalized exanthematous pustulosis; Hydroxychloroquine; Rheumatoid arthritis

MeSH Terms

Acute Generalized Exanthematous Pustulosis
Arthritis, Rheumatoid
Biopsy
Erythema
Erythrocytes
Female
Fever
Humans
Hydroxychloroquine
Leukocytosis
Neutrophils
Skin
Hydroxychloroquine

Figure

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  Fig. 1 Skin lesions of the patient with numerous erythematous small pustules on the whole body.

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  Fig. 2 Histologic examination of a skin biopsy of an erythmatous lesion on the trunk, showing multiple neutrophilic pustules and hyperkeratosis in the epidermis and diffuse infiltration of neutrophils and scattered eosinohpils in the epidermis and dermis (H&E: A, ×100; B, ×200).

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