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Acute generalized exanthematous pustulosis ... - Wiley Online Library
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Acute generalized exanthematous pustulosis ... - Wiley Online Library
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Yoshiki Tokura
http://orcid.org/0000-0001-7452-6919. Yurika Masuda MD. Masahiro Aoshima MD. Takatoshi Shimauchi MD, PhD. Atsuko Funakoshi PhD.
DOI: 10.1002/cia2.12020
LETTER TO THE EDITOR
Acute generalized exanthematous pustulosis caused by fexofenadine Dear Editor,
blood mononuclear cells (PBMCs), but IL-8 may be elaborated in the
Acute generalized exanthematous pustulosis (AGEP) is a diffuse pus-
skin local milieu.
tular disorder characterized by small, nonfollicular, sterile pustules
A previously healthy 31-year-old woman was referred to us for a
with widespread edema and erythema and by fever and leukocyto-
skin eruption that occurred three days ago. One day before, she was
sis.1,2 Subcorneal infiltration of neutrophils is the histopathological
administered with a combination tablet of fexofenadine and pseu-
feature. The majority of the cases are induced by adverse drug reac-
doephedrine (DellegraĆ¢) for rhinitis. Six hours after the administra-
1
tions. Lymphocyte transformation test (LTT) is usually positive with
tion, the patient developed an erythematous eruption on her limbs
high levels of stimulation index (SI) toward drugs in AGEP.3 Drug-
with general fatigue, vomiting, and fever. On examination, she had
specific T cells are present in the blood and secrete interleukin-8
diffuse erythema on the four extremities. Notably, small pustules
(IL-8)/CXCL8, a neutrophil chemoattractant.2 However, IL-8 is not
were scattered on the erythematous background (Figure 1A). Blood
only secreted by T cells, but can also be released from epidermal
examination revealed leukocytosis (14 690/ll) with neutrophilia and
keratinocytes.2,4 Th17 cell-derived IL-17 and IL-22 may stimulate
a high CRP level (2.33 mg/dL; normal,
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