Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyDrug Reaction DataReferences

View all Images (29)

Acute generalized exanthematous pustulosis in Adult
Other Resources UpToDate PubMed

Acute generalized exanthematous pustulosis in Adult

Contributors: Erin X. Wei MD, Vivian Wong MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Acute generalized exanthematous pustulosis (AGEP) is an acute febrile pustular eruption that has been reported in infants, children, and adults. In adult patients, it usually occurs as a result of a medication (accounting for about 90% of cases) and rarely follows a viral infection (enterovirus, adenovirus, cytomegalovirus [CMV], Epstein-Barr virus [EBV], hepatitis B, parvovirus B19) or mercury exposure. Pediatric cases may be more commonly associated with infectious causes compared to adults. AGEP in the setting of treatment for COVID-19 infection (including antimalarial and macrolide or cephalosporin antibiotic) has been reported. Brown recluse spider (Loxosceles reclusa) bites have led to AGEP, possibly related to the venom's promotion of interleukin (IL)-8 and granulocyte macrophage colony-stimulating factor (GM-CSF) cytokines.

The syndrome occurs within 2 weeks of starting the inciting medication, usually as soon as 48 hours after initial drug ingestion. Fever, typically up to 39°C (102.2°F), is a near constant feature and persists about 1 week. The rash of AGEP consists of tiny, superficial pustules that develop on erythematous plaques. Burning and pruritus are frequently reported. Lesions resolve within 1-2 weeks with fine, pinpoint areas of desquamation. Mucous membrane involvement occurs in atypical AGEP and its presence portends worse outcome.

Acute localized exanthematous pustulosis, or ALEP, is a localized variant of AGEP. The clinical presentation and course resemble that of AGEP, but the eruption is often localized to the face, neck or chest, and fever is not a common feature. Localized penile and lower extremity involvement has also been reported.

The causative drugs are primarily antibiotics, typically beta-lactam antibiotics (penicillins, aminopenicillins, cephalosporins) and macrolides (azithromycin), but many other drug culprits have been reported, including norfloxacin, calcium channel blockers (eg, diltiazem, nifedipine), antimalarials, doxycycline, vancomycin, isoniazid, carbamazepine, acetaminophen, quinidine, itraconazole, piperazine, NSAIDs (eg, ibuprofen), metronidazole, and pyrimethamine. ALEP has most frequently been reported following beta-lactam antibiotics but has also been described secondary to other antibiotics and a variety of other medication classes.

Codes

ICD10CM:
L27.0 – Generalized skin eruption due to drugs and medicaments taken internally
L53.8 – Other specified erythematous conditions

SNOMEDCT:
702617007 – Acute generalized exanthematous pustulosis

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

Drug Reaction Data

Subscription Required

References

Subscription Required

Last Reviewed:03/28/2021
Last Updated:02/10/2022
Copyright © 2024 VisualDx®. All rights reserved.
Acute generalized exanthematous pustulosis in Adult
A medical illustration showing key findings of Acute generalized exanthematous pustulosis (AGEP) : Fever, Widespread distribution, WBC elevated, Reaction 2 days to 2 weeks after drug
Clinical image of Acute generalized exanthematous pustulosis - imageId=888896. Click to open in gallery.  caption: 'Myriad tiny pustules and background erythema on the face, ear, and neck.'
Myriad tiny pustules and background erythema on the face, ear, and neck.
Copyright © 2024 VisualDx®. All rights reserved.