A Case of Acute Generalized Exanthematous Pustulosis by Cefixime with Oral Mucosal Involvement

Author(s): Ramanachary Namoju*, Mohammed Ismail, Vinay Kumar Golla, Tejaswini Bamini, Thanmaya Lakshmi Akarapu, Deepika Baloju

Journal Name: Current Drug Safety

Volume 15 , Issue 3 , 2020


Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Abstract:

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction characterized by the development of numerous sterile and non-follicular pustules on an erythematous base with no or minimal mucous membrane involvement associated with fever and leucocytosis. Cefixime is a cephalosporin-type beta-lactam antibiotic commonly used for the management of several infections. The Cefixime-induced AGEP cases are known to be rare. Here, we present the case report of a 26-year old female who developed Cefixime-induced AGEP with mucosal membrane involvement. To the best of our knowledge, this is the first case to report the mucosal membrane involvement in Cefixime-induced AGEP. We are presenting this case report to draw the attention on the existence and plethora of symptoms of Cefixime-induced AGEP hoping that the clinicians will reckon these in their differential diagnosis and implement the appropriate management strategies for this rare adverse event in their clinical practice.

Keywords: Cefixime, acute generalized exanthematous pustulosis, mucous membrane involvement, non-follicular pustules, severe cutaneous adverse reaction, erythematous eruption.

[1]
Szatkowski J, Schwartz RA. Acute generalized exanthematous pustulosis (AGEP): A review and update. J Am Acad Dermatol 2015; 73(5): 843-8.
[http://dx.doi.org/10.1016/j.jaad.2015.07.017] [PMID: 26354880]
[2]
De A, Das S, Sarda A, Pal D, Biswas P. Acute generalised exanthematous pustulosis: an update. Indian J Dermatol 2018; 63(1): 22-9.
[http://dx.doi.org/10.4103/ijd.IJD_581_17] [PMID: 29527022]
[3]
Nacaroglu HT, Celegen M, Ozek G, et al. Acute generalized exanthematous pustulosis induced by ceftriaxone use. Postepy Dermatol Alergol 2014; 31(4): 269-71.
[http://dx.doi.org/10.5114/pdia.2014.40938] [PMID: 25254014]
[4]
Feldmeyer L, Heidemeyer K, Yawalkar N. acute generalized exanthematous pustulosis: pathogenesis, genetic background, clinical variants and therapy. Int J Mol Sci 2016; 17(8): 1214.
[http://dx.doi.org/10.3390/ijms17081214] [PMID: 27472323]
[5]
Belz D, Persa OD, Haese S, Hunzelmann N. Acute generalized exanthematous pustulosis caused by ibuprofen-Diagnosis confirmed by patch testing. Contact Dermat 2018; 79(1): 40-1.
[http://dx.doi.org/10.1111/cod.12978] [PMID: 29572854]
[6]
Gambini D, Sena P, Raponi F, et al. Systemic allergic dermatitis presenting as acute generalized exanthematous pustulosis due to betamethasone sodium phosphate. Contact Dermat 2020; 82(4): 250-2.
[http://dx.doi.org/10.1111/cod.13451] [PMID: 31821599]
[7]
Loo CH, Tan WC, Khor YH, Chan LC. A 10-years retrospective study on Severe Cutaneous Adverse Reactions (SCARs) in a tertiary hospital in Penang, Malaysia. Med J Malaysia 2018; 73(2): 73-7.
[PMID: 29703869]
[8]
DaCunha M, Moore S, Kaplan D. Cephalexin-induced acute generalized exanthematous pustulosis. Dermatol Rep 2018; 10(2): 7686.
[http://dx.doi.org/10.4081/dr.2018.7686] [PMID: 30464809]
[9]
Kumar V, Kalaiselvan V, Kumar AP, et al. Cefixime-associated acute generalized exanthematous pustulosis: Rare cases in India. Indian J Pharmacol 2018; 50(4): 204-7.
[http://dx.doi.org/10.4103/ijp.IJP_673_17] [PMID: 30505057]
[10]
Sidoroff A, Dunant A, Viboud C, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR). Br J Dermatol 2007; 157(5): 989-96.
[http://dx.doi.org/10.1111/j.1365-2133.2007.08156.x] [PMID: 17854366]
[11]
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30(2): 239-45.
[http://dx.doi.org/10.1038/clpt.1981.154] [PMID: 7249508]
[12]
Roche G. [Cefixime, the first oral third-generation cephalosporin] Presse Med 1989; 18(32): 1541-4.
[PMID: 2530527]
[13]
Brogden RN, Campoli-Richards DM. Cefixime. A review of its antibacterial activity. Pharmacokinetic properties and therapeutic potential. Drugs 1989; 38(4): 524-50.
[http://dx.doi.org/10.2165/00003495-198938040-00004] [PMID: 2684593]
[14]
Nishio H. An international review of the safety profile of cefixime. Curr Ther Res Clin Exp 1994; 55: 63-7.
[http://dx.doi.org/10.1016/S0011-393X(05)80729-5]
[15]
World Health Organization. WHO Pharmaceuticals Newsletter No. 5, 2016.7 2016. Available from: http://www.who.int/medicines/publications/PharmaNewsletter5_16 .pdf
[16]
Copaescu AM, Bouffard D, Masse MS. Acute generalized exanthematous pustulosis simulating toxic epidermal necrolysis: case presentation and literature review. Allergy Asthma Clin Immunol 2020; 16: 9.
[http://dx.doi.org/10.1186/s13223-020-0407-5] [PMID: 32042284]
[17]
Hotz C, Valeyrie-Allanore L, Haddad C, et al. Systemic involvement of acute generalized exanthematous pustulosis: a retrospective study on 58 patients. Br J Dermatol 2013; 169(6): 1223-32.
[http://dx.doi.org/10.1111/bjd.12502] [PMID: 23855377]
[18]
Kley C, Murer C, Maul JT, Meier B, Anzengruber F, Navarini AA. rapid involution of pustules during topical steroid treatment of acute generalized exanthematous pustulosis. Case Rep Dermatol 2017; 9(1): 135-9.
[http://dx.doi.org/10.1159/000471842]
[19]
Ahmad S, Hunter L, Qin A, Mann BJ, van Hoek ML. Azithromycin effectiveness against intracellular infections of Francisella. BMC Microbiol 2010; 10: 123.
[http://dx.doi.org/10.1186/1471-2180-10-123] [PMID: 20416090]
[20]
Matzneller P, Krasniqi S, Kinzig M, et al. Blood, tissue, and intracellular concentrations of azithromycin during and after end of therapy. Antimicrob Agents Chemother 2013; 57(4): 1736-42.
[http://dx.doi.org/10.1128/AAC.02011-12] [PMID: 23357769]
[21]
Pinho A, Coutinho I, Gameiro A, Gouveia M, Gonçalo M. Patch testing - a valuable tool for investigating non-immediate cutaneous adverse drug reactions to antibiotics. J Eur Acad Dermatol Venereol 2017; 31(2): 280-7.
[http://dx.doi.org/10.1111/jdv.13796] [PMID: 27477905]
[22]
Phillips EJ, Bigliardi P, Bircher AJ, et al. Controversies in drug allergy: testing for delayed reactions. J Allergy Clin Immunol 2019; 143(1): 66-73.
[http://dx.doi.org/10.1016/j.jaci.2018.10.030] [PMID: 30573342]
[23]
Barbaud A, Collet E, Milpied B, et al. Toxidermies group of the French Society of Dermatology. A multicentre study to determine the value and safety of drug patch tests for the three main classes of severe cutaneous adverse drug reactions. Br J Dermatol 2013; 168(3): 555-62.
[http://dx.doi.org/10.1111/bjd.12125] [PMID: 23136927]
[24]
Hansel K, Bellini V, Bianchi L, Brozzi J, Stingeni L. Drug reaction with eosinophilia and systemic symptoms from ceftriaxone confirmed by positive patch test: an immunohistochemical study. J Allergy Clin Immunol Pract 2017; 5(3): 808-10.
[http://dx.doi.org/10.1016/j.jaip.2016.10.009] [PMID: 27923648]
[25]
Salman A, Yucelten D, Akin Cakici O, Kepenekli Kadayifci E. Acute generalized exanthematous pustulosis due to ceftriaxone: report of a pediatric case with recurrence after positive patch test. Pediatr Dermatol 2019; 36(4): 514-6.
[http://dx.doi.org/10.1111/pde.13838] [PMID: 31050838]
[26]
Chaabane A, Aouam K, Gassab L, Njim L, Boughattas NA. Acute generalized exanthematous pustulosis (AGEP) induced by cefotaxime. Fundam Clin Pharmacol 2010; 24(4): 429-32.
[http://dx.doi.org/10.1111/j.1472-8206.2009.00794.x] [PMID: 19925632]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 3
Year: 2020
Published on: 17 November, 2020
Page: [236 - 239]
Pages: 4
DOI: 10.2174/1574886315999200729144555
Price: $65

Article Metrics

PDF: 24