Acute Generalized Exanthematous Pustulosis after Oral Antihistamine
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Keywords
AGEP, Acute generalized exanthematous pustulosis, Drug reaction, Severe cutaneous adverse reaction, Antihistamine, Hydroxyzine
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a cutaneous adverse reaction that may be severe. It is often caused by drug exposure, most commonly antibiotics; however, many others have been implicated. We present a case of hydroxyzine associated AGEP in a 34-year-old man taking the antihistamine for anxiety. The patient presented with a pruritic, erythematous rash on the extremities, trunk and neck. He was initially diagnosed with folliculitis, although Gram stain and culture were negative. With worsening rash, a punch biopsy was performed and showed subcorneal pustules filled with neutrophils, consistent with AGEP. Additional history led to the identification of the causative agent. Hydroxyzine was discontinued, and the patient’s symptoms improved. Although AGEP is usually self-limited, persisting for one to two weeks followed by desquamation, 17 percent of patients will have organ dysfunction and may require hospitalization. Clinicians should be prepared to recognize this potentially severe reaction, particularly when prescribing a new medication, including a common antihistamine, as in this rare case.
References
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