Acute generalized exanthematous pustulosis ... - Wiley Online Library

DOI: 10.1002/cia2.12020

LETTER TO THE EDITOR

Acute generalized exanthematous pustulosis caused by fexofenadine Dear Editor,

blood mononuclear cells (PBMCs), but IL-8 may be elaborated in the

Acute generalized exanthematous pustulosis (AGEP) is a diffuse pus-

skin local milieu.

tular disorder characterized by small, nonfollicular, sterile pustules

A previously healthy 31-year-old woman was referred to us for a

with widespread edema and erythema and by fever and leukocyto-

skin eruption that occurred three days ago. One day before, she was

sis.1,2 Subcorneal infiltration of neutrophils is the histopathological

administered with a combination tablet of fexofenadine and pseu-

feature. The majority of the cases are induced by adverse drug reac-

doephedrine (Dellegraâ) for rhinitis. Six hours after the administra-

1

tions. Lymphocyte transformation test (LTT) is usually positive with

tion, the patient developed an erythematous eruption on her limbs

high levels of stimulation index (SI) toward drugs in AGEP.3 Drug-

with general fatigue, vomiting, and fever. On examination, she had

specific T cells are present in the blood and secrete interleukin-8

diffuse erythema on the four extremities. Notably, small pustules

(IL-8)/CXCL8, a neutrophil chemoattractant.2 However, IL-8 is not

were scattered on the erythematous background (Figure 1A). Blood

only secreted by T cells, but can also be released from epidermal

examination revealed leukocytosis (14 690/ll) with neutrophilia and

keratinocytes.2,4 Th17 cell-derived IL-17 and IL-22 may stimulate

a high CRP level (2.33 mg/dL; normal,