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A case of recurrent acute generalized exanthematous pustulosis mimicking generalized pustular psoriasis: a diagnostic challenge
Ilmi N.
Gazzetta Medica Italiana Archivio Per Le Scienze Mediche
Q4Abstract
Acute generalized exanthema pustulosis (AGEP) is a drug-induced, acute, and severe cutaneous adverse reaction (SCAR) characterized by pustular eruption appearing as small, non-follicular, monomorphic, sterile pustules on erythematous bases accompanied with systemic symptoms such as fever, leukocytosis, and neutrophilia. The condition can be difficult to distinguish with generalized pustular psoriasis (GPP), a severe form of pustular psoriasis. GPP has acute, subacute, and chronic episodes characterized by multiple pustules along with cutaneous inflammation. Differentiating between AGEP and GPP can be clinically and histologically challenging, especially regarding the initial medication prior to the clinical symptoms. We report a case of a 40-year-old female that clinically resembled both AGEP and GPP with a previous history of psoriasis and presented with abrupt generalized erythematous patches and pustules along with fever. Histopathology results showed subcorneal pustules containing neutrophils, lymphocytes, and some eosinophils, without any psoriasiform changes. The patient was treated with methotrexate and combination of antibiotic-anti-inflammatory cream, as well as a moisturizer. After four cycles of methotrexate, the patient showed clinical improvement.