Allergy Asthma Respir Dis AARD Allergy, Asthma & Respiratory Disease 2288-0402 2288-0410 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 10.4168/aard.2013.1.2.176 Case Report Acute generalized exanthematous pustulosis due to hydroxychloroquine in a rheumatoid arthritis patient Lim Hye Jin 1 Jung Ji Hye 1 Kim Min Jeoung 1 Kim Jeoung Min 1 Kang Hye Ran 1 Song Yoon Kyung 1 Hur Jin Wuk 1 2 Kim Sang-Hoon 1 2 Kim Eun Kyung 3 Department of Internal Medicine, Eulji General Hospital, Seoul, Korea. Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea. Department of Pathology, Eulji University School of Medicine, Daejeon, Korea. Correspondence to: Sang-Hoon Kim. Department of Internal Medicine, Eulji General Hospital, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 139-711, Korea. Tel: +82-2-970-8365, Fax: +82-2-970-8621, ksh1134@eulji.ac.kr 06 2013 27 06 2013 1 2 176 178 11 03 2013 14 05 2013 18 05 2013 © 2013 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Acute generalized exanthematous pustulosis (AGEP) is characterized by acute nonfollicular sterile pustules on a background of edematous erythema. Hydroxychloroquine (HCQ), an antimalarial drug, widely used to treat rheumatic and dermatologic diseases. HCQ has been reported to be an uncommon cause of AGEP. We report a 60-year-old woman with rheumatoid arthritis requiring the use of HCQ presented fever and erythematous eruption on the trunk with sterile pustules. Leukocytosis and elevated erythrocyte sedimention rate noted on laboratory examination. On the histopathological examination of the skin biopsy specimen showed neutrophilic infiltration and scattered eosinohpils. The lesions were resolved with removal of HCQ. The clinical course was consistent with the diagnosis of AGEP associated with HCQ. We reported a case of typical AGEP associated with HCQ in a patient with Rheumatoid arthritis. The patient presented resolution from cutaneous lesions with withdrawal of culprit drug, without the need of systemic steroid.

 Acute generalized exanthematous pustulosis Hydroxychloroquine Rheumatoid arthritis Sidoroff A Dunant A Viboud C Halevy S Bavinck JN Naldi L Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR) Br J Dermatol 2007 157 989 996 Roujeau JC Bioulac-Sage P Bourseau C Guillaume JC Bernard P Lok C Acute generalized exanthematous pustulosis: analysis of 63 cases Arch Dermatol 1991 127 1333 1338 Park JJ Yun SJ Lee JB Kim SJ Won YH Lee SC A case of hydroxychloroquine induced acute generalized exanthematous pustulosis confirmed by accidental oral provocation Ann Dermatol 2010 22 102 105 Choi JH Sim HS Jung Y Lee SK A case of acute generalized exanthematous pustulosis induced by hydroxychloroquine Korean J Dermatol 2008 46 138 140 Britschgi M Steiner UC Schmid S Depta JP Senti G Bircher A T-cell involvement in drug-induced acute generalized exanthematous pustulosis J Clin Invest 2001 107 1433 1441 Choi MJ Kim HS Park HJ Park CJ Lee JD Lee JY Clinicopathologic manifestations of 36 korean patients with acute generalized exanthematous pustulosis: a case series and review of the literature Ann Dermatol 2010 22 163 169 Roujeau JC Clinical heterogeneity of drug hypersensitivity Toxicology 2005 209 123 129 Paradisi A Bugatti L Sisto T Filosa G Amerio PL Capizzi R Acute generalized exanthematous pustulosis induced by hydroxychloroquine: three cases and a review of the literature Clin Ther 2008 30 930 940

Skin lesions of the patient with numerous erythematous small pustules on the whole body.

Histologic examination of a skin biopsy of an erythmatous lesion on the trunk, showing multiple neutrophilic pustules and hyperkeratosis in the epidermis and diffuse infiltration of neutrophils and scattered eosinohpils in the epidermis and dermis (H&E: A, ×100; B, ×200).