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Acute generalized exanthematous pustulosis
From WikEM
Contents
Background
- T-cell mediated rash with systemic features
- >90% of cases attributable to a medication (usually an antibiotic)
- Mortality rate of ~5%
Clinical Features
- Onset 1-5 days after starting causative medication
- Rash:
- Large areas of edematous erythema with numerous small, non-follicular pustules
- Predominantly affects main body folds and upper trunk, but can involve face
- NO mucous membrane involvement (in contrast to SJS/TEN)
- Systemic findings:
- Fever
- Leukocytosis, specifically neutrophilia
- +/- Facial swelling
- +/- Hepatitis
- +/- Eosinophilia
Differential Diagnosis
- Erythema Multiforme
- Stevens-Johnson syndrome and toxic epidermal necrolysis
- Staphylococcal scalded skin syndrome
- Erythroderma
- Toxic Shock Syndrome
- Drug eruption
- DRESS syndrome
Evaluation
- Clinical diagnosis
- CBC
- BMP
- LFTs
Management
- Stop inciting agent
- IVF- treat similar to fluid resuscitation in burns
- Wound care, infection control
Disposition
- Admit
