Man with Rash and Nausea

Article Outline

• Diagnosis
  • Acute generalized exanthematous pustulosis after cephalexin use
• Reference
• Copyright

[Ann Emerg Med. 2011;58:508.]

A 58-year-old man presented to the emergency department (ED) with a 1-day history of rash and 3 days of nausea, vomiting, and diarrhea. His history was notable for recent hair transplantation and cephalexin use. He had finished his antibiotic course 5 days before presentation. He denied skin tenderness, oral ulcers, and history of skin disorders. On arrival, he had a pulse rate of 110 beats/min, respiratory rate of 32 breaths/min, blood pressure of 118/82 mm Hg, temperature of 40.9°C (105.6°F), and an oxygen saturation of 98% on 15 L/minute. About 24 hours before presentation, he noticed erythema in his groin, neck, and axillae and temperature to 40°C (104°F). The rash rapidly spread to his entire body, including his face (Figure 1, Figure 2, Figure 3). At presentation, systemic symptoms continued and rash persisted as diffuse erythematous reticulated rash with grouped, nonfollicularly centered pustules, with no vesicles or bullae.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 1. 

  An erythematous reticulated rash on patient's trunk.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 2. 

  Grouped nonfollicularly centered pustules on the forehead.

• 
  • View Large Image
  • Download to PowerPoint

• Figure 3. 

  Grouped nonfollicularly centered pustules on the neck. Used with permission of Jennie A. Buchanan, MD, Department of Emergency Medicine, Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, Denver, CO.

Back to Article Outline

Diagnosis 

Acute generalized exanthematous pustulosis after cephalexin use 

A diagnosis of acute generalized exanthematous pustulosis as a result of cephalexin was made in the emergency department. The patient was admitted for 2 days and received systemic and topical steroids; the rash significantly improved.

The incidence of acute generalized exanthematous pustulosis is estimated to be 1 to 5 cases per million per year, and 90% are drug induced. Antibiotics are the most frequent cause. Acute generalized exanthematous pustulosis presents acutely with dozens of nonfollicular sterile pustules on a diffuse erythema predominantly in intertriginous areas and on the face. Fever and increased blood neutrophil levels are common. Treatment consists of cessation of causative agent, supportive care, and use of steroids in severe cases.¹

Back to Article Outline

Reference 

1. Sidoroff A, Halevy S, Bavinck JNB, et al. Acute generalized exanthematous pustulosis (AGEP): a clinical reaction pattern. J Cutan Pathol. 2001;28:113–119
   • View In Article
   • MEDLINE
   • CrossRef