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Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, Dodiuk-Gad RP. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. Am J Clin Dermatol 2023:10.1007/s40257-023-00779-3. [PMID: 37156992 PMCID: PMC10166469 DOI: 10.1007/s40257-023-00779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/10/2023]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, New York, NY, USA
| | - Hemali Shah
- Albany Medical College, Albany, New York, NY, USA
| | - Alexander A Navarini
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Beda Muehleisen
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Roni P Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Afula, Israel.
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433, Israel.
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Luo F, Yuan XM, Xiong H, Yang YZ, Chen CM, Ma WK, Yao XM. Clinical features of acute generalized exanthematous pustulosis caused by hydroxychloroquine in rheumatology patients and exploration of CARD14 gene mutations. Front Med (Lausanne) 2023; 10:1161837. [PMID: 37089611 PMCID: PMC10117770 DOI: 10.3389/fmed.2023.1161837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionAcute generalized exanthematous pustulosis (AGEP) is a rare condition characterized by superficial pustules following drug ingestion or infection. Currently, there is no clear link between rheumatism and AGEP. It has been described that hydroxychloroquine (HCQ) is a rare cause of acute generalized epidermal necrolysis (AGEP). Presently, there are limited studies on HCQ-induced AGEP. We aimed to explore the clinical features and associated gene expression of AGEP induced after HCQ treatment exposure in rheumatology patients.MethodsWe assessed patients with HCQ-induced AGEP diagnosed at the Second Affiliated Hospital of Guizhou University of Chinese Medicine between January 1, 2017, and May 1, 2022. We also reviewed similar cases reported in specific databases.ResultsThe study included five females (mean age, 40.2 years), and the mean time from initiation of HCQ treatment to symptom onset was 12.2 d. All patients received steroids and allergy medications after HCQ discontinuation, and the rash completely resolved within an average of 25.2 d. We performed whole exome sequencing and Sanger validation in our patient sample. CARD14 gene mutations were detected in three patients. Additionally, seven mutation sites were detected.DiscussionHCQ-induced AGEP may have a longer latency period and regression time than AGEP induced by other drugs. Our patients all experienced CARD14 gene mutations. AGEP often resolves with topical therapy and drug discontinuation, although some cases require systemic steroid therapy. In the future, patients with rheumatism should pay attention to the effectiveness of HCQ during treatment and be aware of the associated skin toxicity.
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Affiliation(s)
- Feng Luo
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Xue-mei Yuan
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Hong Xiong
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Yu-zheng Yang
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | - Chang-ming Chen
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Wu-kai Ma
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
| | - Xue-ming Yao
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang, China
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Guizhou University of Chinese Medicine, Guiyang, China
- *Correspondence: Xue-ming Yao,
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Acute Generalized Exanthematous Pustulosis following SARS-CoV-2 Virus: Remdesivir as a Suspected Culprit. Case Rep Med 2022; 2022:9880827. [PMID: 35991338 PMCID: PMC9385380 DOI: 10.1155/2022/9880827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 11/28/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is an exanthematous condition, predominantly occurring as a result of drug reactions. We, hereby, present the first case of AGEP following treatment with remdesivir in a patient with COVID-19, without hydroxychloroquine use, which serves as a reminder to consider remdesivir as a possible causative agent when dealing with AGEP presentation in COVID patients.
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Safety of Short-Term Treatments with Oral Chloroquine and Hydroxychloroquine in Patients with and without COVID-19: A Systematic Review. Pharmaceuticals (Basel) 2022; 15:ph15050634. [PMID: 35631460 PMCID: PMC9144263 DOI: 10.3390/ph15050634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 01/09/2023] Open
Abstract
Chloroquine (CQ) and hydroxychloroquine (HCQ) have recently become the focus of global attention as possible treatments for Coronavirus Disease 2019 (COVID-19). The current systematic review aims to assess their safety in short treatments (≤14 days), whether used alone or in combination with other drugs. Following the PRISMA and SWiM recommendations, a search was conducted using four health databases for all relevant English-, Chinese-, and Spanish-language studies from inception through 30 July 2021. Patients treated for any condition and with any comparator were included. The outcomes of interest were early drug adverse effects and their frequency. A total of 254 articles met the inclusion criteria, including case and case-control reports as well as cross-sectional, cohort, and randomised studies. The results were summarised either qualitatively in table or narrative form or, when possible (99 studies), quantitatively in terms of adverse event frequencies. Quality evaluation was conducted using the CARE, STROBE, and JADAD tools. This systematic review showed that safety depended on drug indication. In COVID-19 patients, cardiac adverse effects, such as corrected QT interval prolongation, were relatively frequent (0–27.3% and up to 33% if combined with azithromycin), though the risk of torsade de pointes was low. Compared to non-COVID-19 patients, COVID-19 patients experienced a higher frequency of cardiac adverse effects regardless of the regimen used. Dermatological adverse effects affected 0–10% of patients with autoimmune diseases and COVID-19. A broad spectrum of neuropsychiatric adverse effects affected patients treated with CQ for malaria with variable frequencies and some cases were reported in COVID-19 patients. Gastrointestinal adverse effects occurred regardless of drug indication affecting 0–50% of patients. In conclusion, CQ and HCQ are two safe drugs widely used in the treatment of malaria and autoimmune diseases. However, recent findings on their cardiac and neuropsychiatric adverse effects should be considered if these drugs were to be proposed as antivirals again.
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Yan C, Shang Q, Geng S. Hydroxychloroquine-induced acute generalized exanthematous pustulosis in an orofacial granulomatosis patient with homozygous IL36RN mutation. Dermatol Ther 2022; 35:e15587. [PMID: 35575468 DOI: 10.1111/dth.15587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/10/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Cong Yan
- Northwest Women's and Children's Hospital, Department of Dermatology, 1616 Qu Jiang Street, Xi'an, Shaanxi Province, CN
| | - Qian Shang
- Northwest Hospital, The second affiliated hospital of Xi'an Jiaotong University, Department of Dermatology, 157 Xi Wu Road, Xi'an, Shaanxi, CN, 710004
| | - Songmei Geng
- Northwest Women's and Children's Hospital, Department of Dermatology, 1616 Qu Jiang Street, Xi'an, Shaanxi Province, CN
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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; 11:397. [PMID: 35054090 PMCID: PMC8780223 DOI: 10.3390/jcm11020397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.
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Affiliation(s)
- Enriqueta Vallejo-Yagüe
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Adrian Martinez-De la Torre
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Omar S Mohamad
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Shweta Sabu
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
| | - Andrea M Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, CH-8093 Zurich, Switzerland
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Chaabouni R, Bahloul E, Ennouri M, Atheymen R, Sellami K, Marrakchi S, Charfi S, Boudaya S, Amouri M, Bougacha N, Turki H. Hydroxychloroquine-induced acute generalized exanthematous pustulosis: a series of seven patients and review of the literature. Int J Dermatol 2021; 60:742-748. [PMID: 33598928 DOI: 10.1111/ijd.15419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/07/2020] [Accepted: 12/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hydroxychloroquine (HCQ)-induced acute generalized exanthematous pustulosis (AGEP) is poorly described in the literature. The aim of our study was to characterize the clinical, laboratory, allergological, and genetic features of HCQ-induced AGEP. METHODS We conducted a retrospective study of patients with HCQ-induced AGEP diagnosed between 2011 and 2019. We performed molecular analysis to identify variations in the IL36RN gene. We also reviewed similar cases reported between 1991 and March 2020. RESULTS Seven female patients were included. The mean age was 47 years old, and the average time from HCQ start to onset of symptoms was 40 days. All patients received topical steroids with a full resolution of the rash within an average of 39 days after HCQ withdrawal. Patch tests were performed for three patients with positive results in one case. Genetic analyses were performed for three patients, and no mutation in the IL36RN gene was identified. CONCLUSION The latent period and the duration for resolution of HCQ-induced AGEP may be longer than with other drugs due to the metabolic characteristics of HCQ. Mutations in the IL36RN gene were not identified in our patients.
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Affiliation(s)
- Rim Chaabouni
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Emna Bahloul
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mariam Ennouri
- Molecular and Functional Genetics Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
| | - Rim Atheymen
- Laboratory of Pharmacology, Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - Khadija Sellami
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Slaheddine Marrakchi
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Slim Charfi
- Laboratory of Pathological Anatomy, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Sonia Boudaya
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Meriem Amouri
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Noura Bougacha
- Molecular and Functional Genetics Laboratory, Department of Life Sciences, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia
| | - Hamida Turki
- Department of Dermatology, Hedi Chaker Hospital, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Sharma AN, Mesinkovska NA, Paravar T. Characterizing the adverse dermatologic effects of hydroxychloroquine: A systematic review. J Am Acad Dermatol 2020; 83:563-578. [DOI: 10.1016/j.jaad.2020.04.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 11/26/2022]
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Mercogliano C, Khan M, Lin C, Mohanty E, Zimmerman R. AGEP overlap induced by hydroxychloroquine: a case report and literature review. J Community Hosp Intern Med Perspect 2018; 8:360-362. [PMID: 30559945 PMCID: PMC6292357 DOI: 10.1080/20009666.2018.1547089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 11/02/2018] [Indexed: 01/19/2023] Open
Abstract
Acute Generalized Exanthematous Pustulosis (AGEP) is a rare drug reaction manifesting as pustular lesions with surrounding erythema following exposure. The disease is often self-limited and treatment is supportive. It may present in an atypical variant with vesicles that desquamate into erosions, which classifies the disease as an AGEP/SJS Overlap. This overlap syndrome can carry a substantial mortality rate and necessitate elevation in the level of care. Hydroxychloroquine has been implicated in cases of AGEP, and we present a case of AGEP/SJS overlap attributed to this common medication. Given the prevalence of drug eruptions, it is critical for the physicians to recognize and not overlook this rare and potentially fatal dermatological emergency.
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Affiliation(s)
- Christopher Mercogliano
- Department of Internal Medicine, Reading Hospital and Medical Center, Tower Health, Reading, PA, USA
| | - Muhammad Khan
- Department of Internal Medicine, Reading Hospital and Medical Center, Tower Health, Reading, PA, USA
| | - Catherine Lin
- Department of Internal Medicine, Reading Hospital and Medical Center, Tower Health, Reading, PA, USA
| | - Elan Mohanty
- Department of Internal Medicine, Reading Hospital and Medical Center, Tower Health, Reading, PA, USA
| | - Ryan Zimmerman
- Department of Internal Medicine, Reading Hospital and Medical Center, Tower Health, Reading, PA, USA
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Mohaghegh F, Jelvan M, Rajabi P. A case of prolonged generalized exanthematous pustulosis caused by hydroxychloroquine-Literature review. Clin Case Rep 2018; 6:2391-2395. [PMID: 30564334 PMCID: PMC6293130 DOI: 10.1002/ccr3.1811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/07/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a self-limited drug reaction. Hydroxychloroquine (HCQ) is an uncommon cause of AGEP with a prolonged recovery course; Thus, the physicians should take the possibility of this rare but severe event in their minds and try to diagnose correctly and better management.
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Affiliation(s)
- Fatemeh Mohaghegh
- Assistant Professor of Dermatology and DermatopathologyDepartment of DermatologyIsfahan University of Medical SciencesIsfahanIran
| | - Minoo Jelvan
- Dermatology ResidentDepartment of DermatologyIsfahan university of Medical SciencesIsfahanIran
| | - Parvin Rajabi
- ProfessorDepartment of PathologyIsfahan University of Medical SciencesIsfahanIran
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11
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Duman H, Topal IO, Kocaturk E, Cure K, Mansuroglu I. Acute generalized exanthematous pustulosis induced by hydroxychloroquine: a case with atypical clinical presentation. An Bras Dermatol 2018; 92:404-406. [PMID: 29186260 PMCID: PMC5514588 DOI: 10.1590/abd1806-4841.20175561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/23/2016] [Indexed: 11/22/2022] Open
Abstract
Acute generalized exanthematous pustulosis is a rare drug-induced eruption that is characterized by acute, nonfollicular sterile pustules on an erythematous and edematous base. The most frequently implicated drugs are beta-lactam antibiotics. Hydroxychloroquine has been widely used to treat dermatologic and rheumatologic diseases and has been reported as a rare cause of acute generalized exanthematous pustulosis. A 42-year-old female presented with pustular lesions on the skin surface with erythema, facial edema, and occasional atypical target-like lesions after 21 days of treatment with 200mg/day hydroxychloroquine for rheumatoid arthritis, diagnosed one month previously. We report a case with acute generalized exanthematous pustulosis induced by hydroxychloroquine and treated with dapsone and systemic corticosteroid.
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Affiliation(s)
- Hatice Duman
- Department of Dermatology, Okmeydani Training and Research Hospital - Istanbul, Turkey
| | - Ilteris Oguz Topal
- Department of Dermatology, Okmeydani Training and Research Hospital - Istanbul, Turkey
| | - Emek Kocaturk
- Department of Dermatology, Okmeydani Training and Research Hospital - Istanbul, Turkey
| | - Kubra Cure
- Department of Dermatology, Okmeydani Training and Research Hospital - Istanbul, Turkey
| | - Ilknur Mansuroglu
- Department of Pathology, Okmeydani Training and Research Hospital - Istanbul, Turkey
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McDonald KA, Pierscianowski TA. A Case of Amoxicillin-Induced Acute Generalized Exanthematous Pustulosis Presenting as Septic Shock. J Cutan Med Surg 2017; 21:351-355. [PMID: 28358593 DOI: 10.1177/1203475417701421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This case report demonstrates the challenges of diagnosing and managing acute generalized exanthematous pustulosis (AGEP) presenting as septic shock. The disseminated, erythematous, pustular rash is a common feature. However, extensive organ involvement and life-threatening hypotension are unusual. The constellation of signs has not previously been documented following amoxicillin therapy. Toxic epidermal necrolysis (TEN) and toxic shock syndrome (TSS) were considered in addition to AGEP because of the systemic presentation. AGEP was diagnosed following histopathology (TEN was ruled out based on limited necrotic keratinocytes and lack of epidermal necrosis) and a negative antistreptolysin O titer (eliminated TSS). Antibiotic therapy for septic shock was provided before the diagnosis was confirmed as AGEP. Upon confirmation of the AGEP diagnosis, antibiotics were discontinued and a 5-day course of oral prednisone (40 mg/d) was initiated in addition to topical half-strength (0.05%) betamethasone valerate. The patient rapidly improved and was discharged. Outpatient patch testing confirmed amoxicillin as the culprit drug. In conclusion, it is critical to realize that AGEP cannot be ruled out with a septic shock presentation. Recent drug history is critical in recognizing an adverse drug reaction, and patch testing is useful for determining the culpable drug when the diagnosis is AGEP.
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Abstract
The term "drug reactions" is relevant to dermatology in three categories of reactions: cutaneous drug reactions without systemic features, cutaneous drug reactions with systemic features, and systemic drugs prescribed by the dermatologist with systematic adverse effects. This article uses examples from each of these categories to illustrate several important principles central to drug reaction diagnosis and management. The information presented will help clinicians attain the highest possible level of certainty before making clinical decisions.
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Affiliation(s)
- Stephen E Wolverton
- Department of Dermatology, Indiana University, 545 Barnhill Drive, Emerson Hall 139, Indianapolis, IN 46202, USA.
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14
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Charfi O, Kastalli S, Sahnoun R, Lakhoua G. Hydroxychloroquine-induced acute generalized exanthematous pustulosis with positive patch-testing. Indian J Pharmacol 2016; 47:693-4. [PMID: 26729969 PMCID: PMC4689031 DOI: 10.4103/0253-7613.169589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction, mostly induced by drugs. Hydroxychloroquine have been rarely reported in literature as a causative drug of this reaction. We report a case of AGEP induced by hydroxychloroquine with systemic involvement and confirmed by positive patch testing.
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Affiliation(s)
- Ons Charfi
- Department of Pharmacology, National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis, Tunisia
| | - Sarrah Kastalli
- Department of Pharmacology, National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis, Tunisia; Department of Pharmacology, Tunis El Manar University, Faculty of Medicine, 15 Rue Djebel Lakhdhar, La Rabta, 1007, Tunis, Tunisia
| | - Rym Sahnoun
- Department of Pharmacology, National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis, Tunisia; Department of Pharmacology, Tunis El Manar University, Faculty of Medicine, 15 Rue Djebel Lakhdhar, La Rabta, 1007, Tunis, Tunisia
| | - Ghozlane Lakhoua
- Department of Pharmacology, National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis, Tunisia; Department of Pharmacology, Tunis El Manar University, Faculty of Medicine, 15 Rue Djebel Lakhdhar, La Rabta, 1007, Tunis, Tunisia
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15
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Yalçın B, Çakmak S, Yıldırım B. Successful Treatment of Hydroxychloroquine-Induced Recalcitrant Acute Generalized Exanthematous Pustulosis with Cyclosporine: Case Report and Literature Review. Ann Dermatol 2015; 27:431-4. [PMID: 26273160 PMCID: PMC4530154 DOI: 10.5021/ad.2015.27.4.431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 11/14/2014] [Accepted: 11/21/2014] [Indexed: 11/08/2022] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a cutaneous reaction principally induced by drugs. Spontaneous resolution is observed in most patients. However, severe cases required systemic corticosteroid administration. Hydroxychloroquine, which is used to treat some dermatologic and rheumatologic diseases because of its anti-inflammatory and immunosuppressive effects, is an uncommon cause of AGEP. A 67-year-old female patient presented with severe AGEP due to hydroxychloroquine treatment. She was recalcitrant to supportive care and systemic corticosteroid treatment butwas successfully treated with cyclosporine. Hydroxychloroquine-induced AGEP occurs in women with underlying rheumatologic diseases, has a longer latent period, and has a severe course usually requiring systemic treatment.
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Affiliation(s)
- Başak Yalçın
- Department of Dermatology, Yildirim Beyazit University, Ankara, Turkey
| | - Seray Çakmak
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Betül Yıldırım
- Department of Dermatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
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Al-Bari MAA. Chloroquine analogues in drug discovery: new directions of uses, mechanisms of actions and toxic manifestations from malaria to multifarious diseases. J Antimicrob Chemother 2015; 70:1608-21. [PMID: 25693996 PMCID: PMC7537707 DOI: 10.1093/jac/dkv018] [Citation(s) in RCA: 287] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antimalarial drugs (e.g. chloroquine and its close structural analogues) were developed primarily to treat malaria; however, they are beneficial for many dermatological, immunological, rheumatological and severe infectious diseases, for which they are used mostly today. Chloroquine and hydroxychloroquine, two of the most fascinating drugs developed in the last 50 years, are increasingly recognized for their effectiveness in myriad non-malarial diseases. In advanced research, chloroquine and hydroxychloroquine have been shown to have various immunomodulatory and immunosuppressive effects, and currently have established roles in the management of rheumatic diseases, lupus erythematosus (different forms) and skin diseases, and in the treatment of different forms of cancer. Recently, chloroquine analogues have also been found to have metabolic, cardiovascular, antithrombotic and antineoplastic effects. This review is concerned with the lysosomotropic, anti-inflammatory and immunomodulatory mechanisms of chloroquine, hydroxychloroquine, quinacrine and related analogues, and the current evidence for both their beneficial effects and potential adverse manifestations in various diseases.
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Yin Z, Ma L, Xu J, Xia J, Luo D. Pustular drug eruption due to Panax notoginseng saponins. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:957-61. [PMID: 25114505 PMCID: PMC4109629 DOI: 10.2147/dddt.s67015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Panax notoginseng saponins (PNS) are a patented product in the People’s Republic of China, and have extensive effects on the cardiovascular system. Here we report on four elderly patients (one male and three female) with drug eruption induced by PNS injection. All developed a sudden skin rash with pruritus from head to foot, and subsequently accepted hospitalization. In each case, PNS had been used for less than 1 week before appearance of the rash. No specific short-term medications or changes in diet or exposure to environmental factors immediately prior to appearance of the rash were identified. These four patients had some interesting features in common, ie, pustules, fever, and elevated circulating neutrophil counts, which required high-dose, long-term glucocorticoid therapy. To our knowledge, this is the first report of pustular drug eruption induced by PNS and provides a useful reference and warning for clinicians.
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Affiliation(s)
- ZhiQiang Yin
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Jiangsu, People's Republic of China
| | - LiWen Ma
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Jiangsu, People's Republic of China
| | - JiaLi Xu
- Department of Oncology, First Affiliated Hospital of Nanjing Medical University, Jiangsu, People's Republic of China
| | - JiPing Xia
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Jiangsu, People's Republic of China
| | - Dan Luo
- Department of Dermatology, First Affiliated Hospital of Nanjing Medical University, Jiangsu, People's Republic of China
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