Sir,
Acute generalized exanthematous pustulosis (AGEP) is an uncommon disease which is usually caused by systemic medication, and its incidence is reported to be 0.35–5 per million per year [
A 13-year-old boy was hospitalized to the Plastic Surgery Department in our hospital for surgical treatment of scar contracture after extensive burns. He was referred to our department, complaining of high fever and skin rash. In the perioperative period, he was administered ampicillin, cefaclor, non-steroidal anti-inflammatory drugs, acetaminophen, and rabeprazole sodium. Three days after from surgery, itchy erythema appeared to his back. As a result of having been given ampicillin again due to fever, the skin rash spread to a whole body rapidly. Physical examination revealed erythroderma with a number of pinpoint pustules (Figs.
(a) Clinical feature on the trunk showing erythroderma with a number of pinpoint pustules. (b) Pinpoint pustules on the back of the hand.
Symptoms such as hyperemia were not seen in the mucous membrane, and Nikolsky sign was negative. Laboratory data showed elevated white blood cell count (17600/µl, with 81% neutrophils), and C-reactive protein (6.36 mg/dl). Although a little staphylococcuses were detected in pustule, no bacteria were detected in the blood. A skin biopsy showed pustules in the epidermis with spongiform pustules, and perivascular inflammatory cell infiltration, mainly composed of lymphocytes and eosinophils, in the upper dermis (
Histopathological specimen showed spongiform pustules in the epidermis, and perivascular inflammatory cell infiltration, mainly composed of lymphocytes and eosinophils, in the upper dermis (hematoxylin-eosin, original magnification x100).
To date, only six English literature cases of childhood AGEP have been reported. The age of patients were 17 months [
The main differentiation diagnosis is that of generalized pustular psoriasis (GPP). It is often difficult to distinguish both diseases by eruption and histopathology. It is necessary to pay attention to recurrence in long-term clinical progress to distinguish between both diseases, as AGEP only rarely recurs, but GPP recurs many times. In pediatric cases, the differentiation from Kawasaki disease is also necessary, because Kawasaki disease rarely presents with skin rash similar to AGEP, which manifests as an erythematous pustular eruption. Although rare, we should bear in mind that AGEP can occur even in children.
The examination of the patient was conducted according to the Declaration of Helsinki principles.