Severe flucloxacillin‐induced acute generalized exanthematous pustulosis (AGEP), with toxic epidermal necrolysis (TEN)‐like features: does overlap between AGEP and TEN exist? Clinical report and review of the literature

Summary Acute generalized exanthematous pustulosis (AGEP) and Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) are rare but severe cutaneous adverse drug reactions. Especially in TEN, large areas of the skin and mucosae may become detached. Although AGEP and SJS/TEN are distinct entities with a different clinical picture, pathogenesis, prognosis and treatment, they may share some features, raising the hypothesis of overlap between both entities. We present a severe case of AGEP, caused by flucloxacillin, clinically presenting with TEN‐like features and pronounced systemic symptoms with haemodynamic and respiratory instability. Furthermore, we present a review of the literature on cases of AGEP with features resembling SJS/TEN or a supposed overlap with SJS/TEN. What's already known about this topic? Acute generalized exanthematous pustulosis (AGEP) can be accompanied by mild systemic involvement. Coalescence of pustules in AGEP can result in clinically toxic epidermal necrolysis (TEN)‐like cutaneous features. Histopathology can assist in the differential diagnosis between AGEP and Stevens–Johnson syndrome or TEN. What does this study add? Flucloxacillin may cause AGEP. Severe neutrophilia in AGEP can contribute to the severity of systemic involvement. A literature review could not substantiate the existence of an AGEP–TEN overlap.