Acute Generalized Exanthematous Pustulosis

Figure

Extensive confluent erythematous macules on both legs with non-follicular pustules.

A 76-year-old male patient presented as an emergency due to a 2-day history of skin changes. Physical examination revealed disseminated erythematous macules and plaques on the trunk and extremities. In the further course, confluence of the macules and non-follicular pustulosis developed in the area of erythema (Figure). Laboratory tests revealed leukocytosis with neutrophils and elevated C-reactive protein. The patient reported that he had been using ramipril for 10 days. A biopsy showed intracorneal pustulosis and superficial perivascular dermatitis involving neutrophil granulocytes. We diagnosed acute generalized exanthematous pustulosis (AGEP). AGEP is a severe skin reaction that is mostly (> 90 %) drug-related. Ramipril was discontinued and the patient received an intravenous prednisolone shot (1 mg/kg). This resulted in a regression in skin changes. With regard to etiology, an association with the use of ramipril is conceivable given the time sequence, but not described in the literature. Typical pharmacological triggers include antimicrobial agents such as aminopenicillins and macrolides.

Dr. med. Inga Hansen, PD Dr. med. Nina Booken, Prof. Dr. med. Stefan Werner Schneider, Klinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interests exists.

Translated from the original German by Christine Rye.

Cite this as: Hansen I, Booken N, Schneider SW: Acute generalized exanthematous pustulosis. Dtsch Arztebl Int 2022; 119: 878b. DOI: 10.3238/arztebl.m2022.0297