Korean J Med.  2011 Oct;81(4):537-542.

Anti-TNFalpha Treatment for Two Cases of Acute Generalized Exanthematous Pustulosis Caused by Rhus Hypersensitivity

• Kim IS
• Kim JH
• Kang EJ
• Jang EJ
• Jin HJ
• Park HS
• Ye YM

Abstract

Acute generalized exanthematous pustulosis (AGEP) is characterized by the rapid occurrence of many sterile, nonfollicular pustules on an edematous erythema accompanied by leucocytosis and fever. It is usually attributed to drugs, including herbal medications such as rhus in Korea. We report two cases of AGEP due to rhus hypersensitivity treated with anti-tumor necrosis factor (TNF)-alpha. The patients developed a generalized erythematous rash and edema, particularly on the face, with high fever and leukocytosis several days after ingesting rhus chicken or contacting rhus extract. Following treatment with a systemic steroid, the skin rash spread to the entire body and pustules arose on an edematous erythema. After stopping the systemic steroid and administering a subcutaneous injection of Etanercept, the pustular rashes, fever, and edema improved within 4 days. These results suggest that anti-TNF-alpha treatment may be effective for rapidly improving AGEP.

Keyword

Acute generalized exanthematous; Rhus; TNFR-Fc fusion protein

MeSH Terms

Acute Generalized Exanthematous Pustulosis
Chickens
Edema
Erythema
Exanthema
Fever
Humans
Hypersensitivity
Immunoglobulin G
Injections, Subcutaneous
Korea
Leukocytosis
Necrosis
Receptors, Tumor Necrosis Factor
Rhus
Etanercept
Immunoglobulin G
Receptors, Tumor Necrosis Factor