A case of acute generalized exanthematous pustulosis

Abstract

Acute generalized exanthematous pustulosis (AGEP) has symptoms of abrupt onset of a widespread pustular eruption on an erythematous base. Most cases appear to be related to drug reactions, mainly antibioties, but viral infections and hypersensitivity to mercury may cause AGEP. The essential features of AGEP include: (1) numerous (several dozen) small (< 5mm), mostly non-follicular pustules arising on a widespread erythema: purpura and target-like lesions may be associated; (2) histology showing intraepidermal or subcorneal pustules associated with one or more of the following: dermal edema, vasculitis, perivascular eosinophils, or focal necrosis of keratinocytes; (3) fever (over 38°C); (4) neutrophilia; and (5) acute evolution with spontaneous resolution of pustules within 15 days. We report a case of AGEP which presented with widespread tiny pustules on the whole body except the face, palms and soles, there were petechia, purpura, and vesiculobullous lesions on the axilla, popliteal fossa and upper abdomen. A biopsy specimen from a pustule showed subcorneal pustules with perivascular polymorphous cellular infiltration, marked dermal edema and necrotic keratinocytes. There was complete resolution of the lesions within 10 days.