Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reac...Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics.展开更多
BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of A...BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of AGEP is estimated to be 1-5 cases per million.Cases of AGEP with oral mucosa involvement have been reported.However,reports of AGEP involving airway mucosa are limited.CASE SUMMARY We report a 42-year-old woman with serious AGEP involving the airway mucosa.The patient initially developed fever and a small rash on her forehead and face.Over the next 2 d,she developed a diffuse,pustular rash over her trunk and legs.In addition,she complained of a cough with white foam-like sputum,chest tightness and dyspnea.Four days later,due to dyspnea,her mental status started to gradually deteriorate.She became more and more drowsy.Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP.According to the European study of severe cutaneous adverse reactions group’s scoring system,the patient scored+6 indicating a probable diagnosis of AGEP.She received intravenous methylprednisolone 120 mg/12 h for 3 d,and was eventually discharged in good condition.This patient had already experienced respiratory failure and airway mucosa involvement on admission;however,the clinicians had an insufficient understanding of AGEP.Glucocorticoid was administered for more than 10 d following onset of the disease,and her overall prognosis was satisfactory.CONCLUSION This case represents a rare clinical feature of AGEP and an important finding for clinicians.展开更多
目的研究引起妊娠期急性泛发型发疹性脓疱病的药物种类及该病的临床表现、病程特点和愈后情况。方法检索PubMed、EMBASE、Web of Science、中国知网、万方数据库、维普数据库、中华医学会期刊全文数据库(截至2023年4月30日),收集药物致...目的研究引起妊娠期急性泛发型发疹性脓疱病的药物种类及该病的临床表现、病程特点和愈后情况。方法检索PubMed、EMBASE、Web of Science、中国知网、万方数据库、维普数据库、中华医学会期刊全文数据库(截至2023年4月30日),收集药物致妊娠期AGEP的病例信息【国籍、年龄、孕周、过敏史、银屑病史、诱因、用药途径(药物)、发病时间、临床表现及辅助检查、处置及转归、皮肤活检情况】,并对其进行描述性统计分析。结果纳入患者14例,包括早期妊娠2例、中期妊娠4例和晚期妊娠8例,平均年龄32岁(23~39岁);1例诱因为流感疫苗,其余13例均考虑由药物【抗菌药物7例(53.85%)和米非司酮、拉贝洛尔、奥美拉唑、羟氯喹、对乙酰氨基酚、间苯三酚各1例(7.69%)】引发。发病时间从几小时到几十天不等。所有患者均愈后良好,转归时间2~15 d。不同妊娠时期和不同用药途径的发病时间、转归时间均无统计学差异(P>0.05)。结论多种临床常用药物可引发妊娠期AGEP,大多发生在用药3 d内,临床表现典型,及时停药后酌情予对症支持治疗,愈后良好。展开更多
文摘Background: The use of antibiotics, especially beta-lactams and macrolides, may be associated with dermatopathies, such as Acute Generalized Exanthematous Pustulosis (AGEP), which is an uncommon cutaneous adverse reaction. Case: We report a case of AGEP, in a 36-year-old multiparous (G5P3C1A1) woman, with 38 weeks of gestation, admitted to the hospital to induce labor. Due to cephalopelvic disproportion, the cesarean section was indicated. In the postoperative period, the patient evolved with cutaneous rash, accompanied by productive cough and dyspnea. Because it was a fever of obscure origin, the treatment with antibiotics, including azithromycin, was initiated. On subsequent days, she presented pustules on the back, abdomen and extremities. Such reaction was attributed to the use of azithromycin. When the drug was discontinued, the lesions regressed significantly. Conclusion: The clinical picture of AGEP may occur with persistent high fever and therefore could be confused with systemic infections, consequently, being treated with wrong medications capable of aggravating the adverse cutaneous reaction, worsening the course of the disease that could be easily treated by stopping the use of the causative drug. This case shows the importance of including AGEP as a differential diagnosis of dermatopathies in the pregnancy-puerperal cycle, especially in women who are using various medications, including antibiotics.
文摘BACKGROUND Acute generalized exanthematous pustulosis(AGEP)is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis.The annual incidence of AGEP is estimated to be 1-5 cases per million.Cases of AGEP with oral mucosa involvement have been reported.However,reports of AGEP involving airway mucosa are limited.CASE SUMMARY We report a 42-year-old woman with serious AGEP involving the airway mucosa.The patient initially developed fever and a small rash on her forehead and face.Over the next 2 d,she developed a diffuse,pustular rash over her trunk and legs.In addition,she complained of a cough with white foam-like sputum,chest tightness and dyspnea.Four days later,due to dyspnea,her mental status started to gradually deteriorate.She became more and more drowsy.Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP.According to the European study of severe cutaneous adverse reactions group’s scoring system,the patient scored+6 indicating a probable diagnosis of AGEP.She received intravenous methylprednisolone 120 mg/12 h for 3 d,and was eventually discharged in good condition.This patient had already experienced respiratory failure and airway mucosa involvement on admission;however,the clinicians had an insufficient understanding of AGEP.Glucocorticoid was administered for more than 10 d following onset of the disease,and her overall prognosis was satisfactory.CONCLUSION This case represents a rare clinical feature of AGEP and an important finding for clinicians.
文摘目的研究引起妊娠期急性泛发型发疹性脓疱病的药物种类及该病的临床表现、病程特点和愈后情况。方法检索PubMed、EMBASE、Web of Science、中国知网、万方数据库、维普数据库、中华医学会期刊全文数据库(截至2023年4月30日),收集药物致妊娠期AGEP的病例信息【国籍、年龄、孕周、过敏史、银屑病史、诱因、用药途径(药物)、发病时间、临床表现及辅助检查、处置及转归、皮肤活检情况】,并对其进行描述性统计分析。结果纳入患者14例,包括早期妊娠2例、中期妊娠4例和晚期妊娠8例,平均年龄32岁(23~39岁);1例诱因为流感疫苗,其余13例均考虑由药物【抗菌药物7例(53.85%)和米非司酮、拉贝洛尔、奥美拉唑、羟氯喹、对乙酰氨基酚、间苯三酚各1例(7.69%)】引发。发病时间从几小时到几十天不等。所有患者均愈后良好,转归时间2~15 d。不同妊娠时期和不同用药途径的发病时间、转归时间均无统计学差异(P>0.05)。结论多种临床常用药物可引发妊娠期AGEP,大多发生在用药3 d内,临床表现典型,及时停药后酌情予对症支持治疗,愈后良好。
