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Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab.
Front Med (Lausanne). 2021; 8:758354.FM

Abstract

Acute generalized exanthematous pustulosis is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base. Most cases of acute generalized exanthematous pustulosis (AGEP) clear quickly with a systemic corticosteroid, but severe or recalcitrant cases may need other systemic therapies. In this case, a man in his 40 s with a history of psoriasis consulted a physician about widespread erythema, pustules, target lesions, and fever after the administration of a quadruple antituberculosis drug. Routine laboratory testing revealed elevated white blood cell count and C-reactive protein. The histopathology showed subcorneal pustules, spongiosis as well as lymphocyte and eosinophils infiltration in the dermis. The patient was diagnosed with definitive AGEP according to the diagnostic score from the EuroSCAR study. Cutaneous lesions especially pustules and erythema multiforme-like lesions on the upper arms and palms are crucial for distinguishing AGEP from Generalized pustular psoriasis. The patient was treated with secukinumab as a result of his failure to respond to topical corticosteroids and constrain of systemic steroids. Remission with secukinumab therapy was safe without increased risks of infections. This case indicates that secukinumab is a potential therapy that can rapidly improve the clinical symptoms of AGEP.

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Authors+Show Affiliations

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Medical Affairs, Beijing Novartis Pharma Company Limited, Shanghai, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

34993208

Citation

Zhang, Liangliang, et al. "Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab." Frontiers in Medicine, vol. 8, 2021, p. 758354.

Zhang L, Xu Q, Lin T, et al. Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab. Front Med (Lausanne). 2021;8:758354.

Zhang, L., Xu, Q., Lin, T., Ruan, S., Lin, M., Bao, C., Zhang, J., Liu, T., Gong, T., & Ji, C. (2021). Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab. Frontiers in Medicine, 8, 758354. https://doi.org/10.3389/fmed.2021.758354

Zhang L, et al. Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab. Front Med (Lausanne). 2021;8:758354. PubMed PMID: 34993208.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Case Report: Successful Treatment of Acute Generalized Exanthematous Pustulosis With Secukinumab. AU - Zhang,Liangliang, AU - Xu,Qiuyun, AU - Lin,Tingting, AU - Ruan,Shifan, AU - Lin,Mengting, AU - Bao,Chengbei, AU - Zhang,Jing, AU - Liu,Tao, AU - Gong,Ting, AU - Ji,Chao, Y1 - 2021/12/16/ PY - 2021/08/13/received PY - 2021/11/05/accepted PY - 2022/1/7/entrez PY - 2022/1/8/pubmed PY - 2022/1/8/medline KW - AGEP KW - biologic KW - drug eruption KW - interleukin-17A inhibition KW - secukinumab SP - 758354 EP - 758354 JF - Frontiers in medicine JO - Front Med (Lausanne) VL - 8 N2 - Acute generalized exanthematous pustulosis is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base. Most cases of acute generalized exanthematous pustulosis (AGEP) clear quickly with a systemic corticosteroid, but severe or recalcitrant cases may need other systemic therapies. In this case, a man in his 40 s with a history of psoriasis consulted a physician about widespread erythema, pustules, target lesions, and fever after the administration of a quadruple antituberculosis drug. Routine laboratory testing revealed elevated white blood cell count and C-reactive protein. The histopathology showed subcorneal pustules, spongiosis as well as lymphocyte and eosinophils infiltration in the dermis. The patient was diagnosed with definitive AGEP according to the diagnostic score from the EuroSCAR study. Cutaneous lesions especially pustules and erythema multiforme-like lesions on the upper arms and palms are crucial for distinguishing AGEP from Generalized pustular psoriasis. The patient was treated with secukinumab as a result of his failure to respond to topical corticosteroids and constrain of systemic steroids. Remission with secukinumab therapy was safe without increased risks of infections. This case indicates that secukinumab is a potential therapy that can rapidly improve the clinical symptoms of AGEP. SN - 2296-858X UR - https://www.unboundmedicine.com/medline/citation/34993208/Case_Report:_Successful_Treatment_of_Acute_Generalized_Exanthematous_Pustulosis_With_Secukinumab_ DB - PRIME DP - Unbound Medicine ER -