Acute Generalized Exanthematous Pustulosis (AGEP)



AGEP is largely a clinical diagnosis based on classical skin findings in a patient who recently started taking one of the commonly implicated agents or had a recent infection.



How?

The mechanism of development is a T-cell-mediated inflammatory response.



Who?

Annual incidence of one to five cases per million people.



Causes?

In about 90% of patients, AGEP is caused by medications.



Antibiotics:

- cephalosporins

- macrolides

- aminopenicillins

- antifungals

- antimalarials

- diltiazem



Infections:

- Parvovirus B19

- Cytomegalovirus

- Coxsackievirus

- Mycoplasma pneumoniae



Diagnostic Criteria:

- Fever onset (temperature above 38 degrees Celsius) and pustular rash shortly after starting a potentially triggering medication.

- Multiple small pustules with underlying redness.

- Elevated white blood cell count with increased neutrophil levels.

- Skin biopsy revealing non-bacterial origin.

- Rash improvement after stopping the triggering substance.



Clinical Presentation?

The rash can be associated with:

- Facial edema

- Purpura

- Blisters

- Vesicles



The rash typically spares mucous membranes, can present with lesions on the lips.



During the acute phase, patients often are febrile (temperature greater than 38°C or 100.4°F). Manifestations generally are limited to the skin.



Labs?

- Leukocytosis and neutrophilia

- Elevated transaminases

- Reduction in creatinine clearance can occur



Typically, the rash resolves spontaneously after removal of the offending agent, with patients unlikely to have any major complications.



- Desquamation of the rash typically begins 5 to 7 days after its onset, with full resolution of the rash within 1 to 2 weeks.

- AGEP can recur with reexposure to the drug, so patients should be counseled to avoid the offending medication for life.



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