![]() DRESS is typically associated with a longer latent period of 2 to 6 weeks. Key differences of pustular psoriasis include slow onset and often personal or family history of psoriasis. The main differentials to be considered for AGEP are pustular psoriasis and drug rash with eosinophilia and systemic symptoms (DRESS), the case authors note. Histologically, features of AGEP are characterized by subcorneal pustules, mild spongiosis in the surrounding epidermis, and superficial mixed infiltrate composed of lymphocytes, neutrophils, and occasional eosinophils. Spontaneous resolution of the pustules in less than 15 days.Spongiform subcorneal or intraepidermal pustules on skin biopsy.Blood neutrophilia (>7,000 neutrophils/μL).The AGEP validation score from by the EuroSCAR study group includes the following diagnostic criteria: Less commonly, AGEP has been associated with exposure to spider bites and mercury.ĭiagnosis is based on clinical presentation and histologic findings. In addition, the authors note, in the time since the pandemic began, there have been numerous reports of associated skin manifestations, including petechial rashes, vesicles, chilblains, and urticaria. ![]() Resolution is marked by desquamation with characteristic collarettes of scale.ĪGEP has also occurred in connection with certain viral infections, including cytomegalovirus, parvovirus B19, and Epstein-Barr virus. The condition is self-limiting, and usually resolves within 2 weeks of withdrawal of the offending drug. The rash generally erupts within 48 hours of exposure to the medication, with even less for antibiotics (median of 24 hours). In addition to antimalarials such as hydroxychloroquine, common culprits include aminopenicillins and diltiazem. The authors of the current case speculate that the man's vigorous immune response to COVID-19, coupled with concurrent cefepime use, may have triggered the appearance of AGEP.ĪGEP is a rare exanthem characterized by the acute development of a multitude (often up to several hundred) of small, non-follicular, sterile pustules arising on an erythematous base, and is usually related to medication use. However, unlike the patient in the first report, published in May 2020 and involving a 39-year-old woman who developed AGEP 18 days after starting hydroxychloroquine treatment, the current patient had not received that drug.
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