Allergy Asthma Respir Dis.  2017 Jan;5(1):52-55. 10.4168/aard.2017.5.1.52.

Acute generalized exanthematous pustulosis presumed to be caused by acetaminophen

• Kim HW
• Choi YS
• Won JH
• Lee JM
• Heo JY
• Choi JA
• Oh MJ

• KMID: 2368577
• DOI: http://doi.org/10.4168/aard.2017.5.1.52

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a severe and rare disease usually related to drug eruption. AGEP is induced by drugs in over 90% of cases with antibiotics being the most common. It is characterized by a fever and a pustular eruption on erythematous skin with acute onset and without follicular localization. Acetaminophen is commonly used as an antipyretic and analgesic. Acetaminophen has been reported to be an uncommon cause of AGEP. We report a 79-year-old woman presenting with fever and erythematous maculopapular eruptions on the trunk with sterile pustules arising upon the use of acetaminophen for back pain. Leukocytosis and elevated C-reactive protein levels were noted on the laboratory examination. The histopathological examination of the skin biopsy specimen showed intraepidermal pustule formation with superficial perivascular lymphocytic infiltration, including eosinophils, and extensive red blood cell extravasation. The lesions were resolved with discontinuation of acetaminophen and use of systemic corticosteroid. We report a case of AGEP probably caused by acetaminophen.

Keyword

Acute generalized exanthematous pustulosis; Acetaminophen; Drug eruption

MeSH Terms

Acetaminophen*
Acute Generalized Exanthematous Pustulosis*
Aged
Anti-Bacterial Agents
Back Pain
Biopsy
C-Reactive Protein
Drug Eruptions
Eosinophils
Erythrocytes
Female
Fever
Humans
Leukocytosis
Rare Diseases
Skin
Acetaminophen
Anti-Bacterial Agents
C-Reactive Protein

Figure

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  Fig. 1 There are multiple nonfollicular, pustular lesions on an erythematous background on the back.

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  Fig. 2 The patient became afebrile the very next day of stopping of paracetamol.

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  Fig. 3 Histologic examination shows intraepidermal pustule formation with superficial perivascular lymphocytic infiltration including eosinophils and extensive red blood cell extravasation (A: H&E, ×100; B: H&E, ×200).

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