Acute Generalized Exanthematous Pustulosis after Oral Antihistamine

Main Article Content

Hannah Riva https://orcid.org/0000-0003-2315-6166
Martin Giandoni
Frank Celis
Cynthia Reyes Barron

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

1. Sidoroff A, Halevy S, Bavinck JN, Vaillant L, Roujeau JC. Acute generalized exanthematous pustulosis (AGEP)--a clinical reaction pattern. J Cutan Pathol. 2001;28(3):113-119.

2. Szatkowski J, Schwartz RA. Acute generalized exanthematous pustulosis (AGEP): A review and update. J Am Acad Dermatol. 2015;73(5):843-848.

3. Vallejo-Yagüe E, Martinez-De la Torre A, Mohamad OS, Sabu S, Burden AM. Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients. J Clin Med. 2022;11(2).

4. O'Toole A, Lacroix J, Pratt M, Beecker J. Acute generalized exanthematous pustulosis associated with 2 common medications: hydroxyzine and benzocaine. J Am Acad Dermatol. 2014;71(4):e147-149.

5. Tsai YS, Tu ME, Wu YH, Lin YC. Hydroxyzine-induced acute generalized exanthematous pustulosis. Br J Dermatol. Vol 157. England2007.