Life-Threatening Atypical Case of Acute Generalized Exanthematous Pustulosis
Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides...
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| Veröffentlicht in: | International archives of allergy and immunology 2017-11, Vol.174 (2), p.108-111 |
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| creator | Tajmir-Riahi, Azadeh Wörl, Petra Harrer, Thomas Schliep, Stefan Schuler, Gerold Simon, Miklos |
| description | Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases. Herein, we report a case of AGEP in a young healthy male leading to systemic inflammatory response syndrome and to treatment in an intensive care unit after being treated with 5 different antibiotics. Initial symptoms were not indicative for AGEP and the patient's course of disease led promptly to critical cardiorespiratory symptoms and systemic inflammatory response syndrome. We assume that the administration of the 5 different antibiotics resulted in type IV allergy as well as secondary infection with Enterococcus faecium and Staphylococcus aureus, while the underlying periodontitis also contributed to the severity of this case. |
| doi_str_mv | 10.1159/000480700 |
| format | Article |
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Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases. Herein, we report a case of AGEP in a young healthy male leading to systemic inflammatory response syndrome and to treatment in an intensive care unit after being treated with 5 different antibiotics. Initial symptoms were not indicative for AGEP and the patient's course of disease led promptly to critical cardiorespiratory symptoms and systemic inflammatory response syndrome. We assume that the administration of the 5 different antibiotics resulted in type IV allergy as well as secondary infection with Enterococcus faecium and Staphylococcus aureus, while the underlying periodontitis also contributed to the severity of this case.</description><identifier>ISSN: 1018-2438</identifier><identifier>EISSN: 1423-0097</identifier><identifier>DOI: 10.1159/000480700</identifier><identifier>PMID: 29065395</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Acute Generalized Exanthematous Pustulosis - diagnosis ; Acute Generalized Exanthematous Pustulosis - pathology ; Adult ; Allergies ; Amoxicillin - adverse effects ; Amoxicillin - immunology ; Amoxicillin - therapeutic use ; Ampicillin - adverse effects ; Ampicillin - immunology ; Ampicillin - therapeutic use ; Anti-Bacterial Agents - adverse effects ; Anti-Bacterial Agents - immunology ; Anti-Bacterial Agents - therapeutic use ; Antibiotics ; Case reports ; Case studies ; Chronic illnesses ; Ciprofloxacin - adverse effects ; Ciprofloxacin - immunology ; Ciprofloxacin - therapeutic use ; Cutaneous manifestations of general diseases ; Diagnosis ; Drug allergy ; Enterococcus faecium - isolation & purification ; Enzymes ; Geriatrics ; Humans ; Inflammation ; Inflammatory response ; Male ; Medical treatment ; Novel Insights from Clinical Practice ; Older people ; Penicillin G - adverse effects ; Penicillin G - immunology ; Penicillin G - therapeutic use ; Periodontitis ; Periodontitis - drug therapy ; Periodontitis - microbiology ; Pustulosis ; Renal function ; Secondary infection ; Staphylococcal Infections - complications ; Staphylococcus aureus - isolation & purification ; Staphylococcus infections ; Stevens-Johnson syndrome ; Sulbactam - adverse effects ; Sulbactam - immunology ; Sulbactam - therapeutic use ; Systemic inflammatory response syndrome ; Systemic Inflammatory Response Syndrome - pathology ; Toxic epidermal necrolysis</subject><ispartof>International archives of allergy and immunology, 2017-11, Vol.174 (2), p.108-111</ispartof><rights>2017 S. Karger AG, Basel</rights><rights>2017 S. Karger AG, Basel.</rights><rights>COPYRIGHT 2017 S. Karger AG</rights><rights>Copyright S. Karger AG Nov 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c467t-1034bf3437a1a79a16daad8cc097bafcb857169bca596008fa663ed4e084d7903</citedby><cites>FETCH-LOGICAL-c467t-1034bf3437a1a79a16daad8cc097bafcb857169bca596008fa663ed4e084d7903</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,2422,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29065395$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tajmir-Riahi, Azadeh</creatorcontrib><creatorcontrib>Wörl, Petra</creatorcontrib><creatorcontrib>Harrer, Thomas</creatorcontrib><creatorcontrib>Schliep, Stefan</creatorcontrib><creatorcontrib>Schuler, Gerold</creatorcontrib><creatorcontrib>Simon, Miklos</creatorcontrib><title>Life-Threatening Atypical Case of Acute Generalized Exanthematous Pustulosis</title><title>International archives of allergy and immunology</title><addtitle>Int Arch Allergy Immunol</addtitle><description>Antibiotics are known to cause severe cutaneous adverse reactions, such as the rare acute generalized exanthematous pustulosis (AGEP). Unlike Stevens-Johnson syndrome or toxic epidermal necrolysis, AGEP is rarely life-threatening. Systemic involvement is not typical, and if present usually coincides with a mild elevation of the hepatic enzymes and a decrease in renal function. Hence, AGEP is known to have a good prognosis and to be life-threatening only in elderly patients or patients with chronic diseases. Herein, we report a case of AGEP in a young healthy male leading to systemic inflammatory response syndrome and to treatment in an intensive care unit after being treated with 5 different antibiotics. Initial symptoms were not indicative for AGEP and the patient's course of disease led promptly to critical cardiorespiratory symptoms and systemic inflammatory response syndrome. We assume that the administration of the 5 different antibiotics resulted in type IV allergy as well as secondary infection with Enterococcus faecium and Staphylococcus aureus, while the underlying periodontitis also contributed to the severity of this case.</description><subject>Acute Generalized Exanthematous Pustulosis - diagnosis</subject><subject>Acute Generalized Exanthematous Pustulosis - pathology</subject><subject>Adult</subject><subject>Allergies</subject><subject>Amoxicillin - adverse effects</subject><subject>Amoxicillin - immunology</subject><subject>Amoxicillin - therapeutic use</subject><subject>Ampicillin - adverse effects</subject><subject>Ampicillin - immunology</subject><subject>Ampicillin - therapeutic use</subject><subject>Anti-Bacterial Agents - adverse effects</subject><subject>Anti-Bacterial Agents - immunology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Case reports</subject><subject>Case studies</subject><subject>Chronic illnesses</subject><subject>Ciprofloxacin - adverse effects</subject><subject>Ciprofloxacin - immunology</subject><subject>Ciprofloxacin - therapeutic use</subject><subject>Cutaneous manifestations of general diseases</subject><subject>Diagnosis</subject><subject>Drug allergy</subject><subject>Enterococcus faecium - isolation & purification</subject><subject>Enzymes</subject><subject>Geriatrics</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Inflammatory response</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Novel Insights from Clinical Practice</subject><subject>Older people</subject><subject>Penicillin G - adverse effects</subject><subject>Penicillin G - immunology</subject><subject>Penicillin G - therapeutic use</subject><subject>Periodontitis</subject><subject>Periodontitis - drug therapy</subject><subject>Periodontitis - microbiology</subject><subject>Pustulosis</subject><subject>Renal function</subject><subject>Secondary infection</subject><subject>Staphylococcal Infections - complications</subject><subject>Staphylococcus aureus - isolation & purification</subject><subject>Staphylococcus infections</subject><subject>Stevens-Johnson syndrome</subject><subject>Sulbactam - adverse effects</subject><subject>Sulbactam - immunology</subject><subject>Sulbactam - therapeutic use</subject><subject>Systemic inflammatory response syndrome</subject><subject>Systemic Inflammatory Response Syndrome - pathology</subject><subject>Toxic epidermal necrolysis</subject><issn>1018-2438</issn><issn>1423-0097</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpt0c2L1DAYBvAgiruuHryLFIQFD13fNG0-jsOwuwoDeljP5W36ZiZr24xJCq5_vZUZRxckh4Twe_LBw9hrDlecN-YDANQaFMATds7rSpQARj1d1sB1WdVCn7EXKd0DLFjL5-ysMiAbYZpzttl4R-XdLhJmmvy0LVb5Ye8tDsUaExXBFSs7ZypuaaKIg_9JfXH9A6e8oxFzmFPxZU55HkLy6SV75nBI9Oo4X7CvN9d364_l5vPtp_VqU9paqlxyEHXnRC0UclQGuewRe23t8uoOne10o7g0ncXGSADtUEpBfU2g614ZEBfs3eHcfQzfZ0q5vQ9znJYrW250oyvBpfirtjhQ6ycXckQ7-mTblRSqqmSlzKKu_qOW0dPobZjI-WX_UeDyn8COcMi7FIY5-zClx_D9AdoYUork2n30I8aHlkP7u7f21Nti3x5_NHcj9Sf5p6gFvDmAbxi3FE_gmP8FDBOYQQ</recordid><startdate>20171101</startdate><enddate>20171101</enddate><creator>Tajmir-Riahi, Azadeh</creator><creator>Wörl, Petra</creator><creator>Harrer, Thomas</creator><creator>Schliep, Stefan</creator><creator>Schuler, Gerold</creator><creator>Simon, Miklos</creator><general>S. 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| ispartof | International archives of allergy and immunology, 2017-11, Vol.174 (2), p.108-111 |
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| source | MEDLINE; Karger Journals Complete; Alma/SFX Local Collection |
| subjects | Acute Generalized Exanthematous Pustulosis - diagnosis Acute Generalized Exanthematous Pustulosis - pathology Adult Allergies Amoxicillin - adverse effects Amoxicillin - immunology Amoxicillin - therapeutic use Ampicillin - adverse effects Ampicillin - immunology Ampicillin - therapeutic use Anti-Bacterial Agents - adverse effects Anti-Bacterial Agents - immunology Anti-Bacterial Agents - therapeutic use Antibiotics Case reports Case studies Chronic illnesses Ciprofloxacin - adverse effects Ciprofloxacin - immunology Ciprofloxacin - therapeutic use Cutaneous manifestations of general diseases Diagnosis Drug allergy Enterococcus faecium - isolation & purification Enzymes Geriatrics Humans Inflammation Inflammatory response Male Medical treatment Novel Insights from Clinical Practice Older people Penicillin G - adverse effects Penicillin G - immunology Penicillin G - therapeutic use Periodontitis Periodontitis - drug therapy Periodontitis - microbiology Pustulosis Renal function Secondary infection Staphylococcal Infections - complications Staphylococcus aureus - isolation & purification Staphylococcus infections Stevens-Johnson syndrome Sulbactam - adverse effects Sulbactam - immunology Sulbactam - therapeutic use Systemic inflammatory response syndrome Systemic Inflammatory Response Syndrome - pathology Toxic epidermal necrolysis |
| title | Life-Threatening Atypical Case of Acute Generalized Exanthematous Pustulosis |
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