Ann Dermatol.  2010 May;22(2):163-169. 10.5021/ad.2010.22.2.163.

Clinicopathologic Manifestations of 36 Korean Patients with Acute Generalized Exanthematous Pustulosis: A Case Series and Review of the Literature

• Choi MJ
• Kim HS
• Park HJ
• Park CJ
• Lee JD
• Lee JY
• Kim HO
• Park YM

• KMID: 2265386
• DOI: http://doi.org/10.5021/ad.2010.22.2.163

Abstract

BACKGROUND
Acute generalized exanthematous pustulosis (AGEP) is a rare and severe subtype of drug eruption, characterized by acute, extensive, non-follicular, sterile pustules on an erythematous background, accompanied by fever and leukocytosis.
OBJECTIVE
The purpose of this study was to characterize AGEP in Korean patients in terms of clinical, laboratory, and pathologic findings.
METHODS
Thirty-six patients (M:F=17:19) with AGEP were identified from an extensive review of medical records over a 15 year period. All patient cases were confirmed by biopsy and fulfilled the diagnostic criteria. RESULTS: The patient ages ranged from 4~80 years (37.6+/-19.4). The incubation period was 1~23 days. The duration of disease was 5~14 days. Neutrophilia (36/36), high CRP (14/36), and eosinophilia (30/36) were common laboratory findings. A history of drug administration existed in 23 of 36 patients; herbal medications, lacquers and radiocontrast media were the unique causative drugs. Spongioform subcorneal or intraepidermal pustules in the epidermis was observed in all patients. Thirty-six patients were subdivided into 2 groups: group A (n=23) was strongly associated with known agents; and group B (n=13) had no identified causative agents. There was no significant difference between the 2 groups.
CONCLUSION
Our results demonstrate the characteristic features of AGEP in Korean patients as follows: lower identification of causative agents; herbal medications, lacquers, and radiocontrast media were the main causative agents; and no significant differences existed between the 2 groups.

Keyword

Acute generalized exanthematous pustulosis; Clinicopathologic manifestation; Korean

MeSH Terms

Acute Generalized Exanthematous Pustulosis
Biopsy
Contrast Media
Drug Eruptions
Eosinophilia
Epidermis
Fever
Humans
Lacquer
Medical Records
Contrast Media

Figure

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  Fig. 1 Multiple, pin-head sized, non-follicular pustules with an erythematous base on the trunk in case 36 (A) and the big folds of lower extremities in case 10 (B).

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  Fig. 2 Several, sterile and small pustules with edematous erythema and exfoliations in case 7.

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  Fig. 3 Marked edema of face and non erosive oral mucosal involvement in case 10.

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  Fig. 4 (A) Spongioform subcorneal pustules consisted of polymorphonuclear leukocytes in the epidermis (H&E, ×100, case 7). (B) Leukocytoclastic vasculitis in the dermis (H&E, ×100, case 1).

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