Acute generalized exanthematous pustulosis due to hydroxychloroquine in a rheumatoid arthritis patient

Hye Jin Lim; Ji Hye Jung; Min Jeoung Kim; Jeoung Min Kim; Hye Ran Kang; Yoon Kyung Song; Jin Wuk Hur; Sang-Hoon Kim; Eun Kyung Kim

doi:10.4168/aard.2013.1.2.176

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Lim, Jung, Kim, Kim, Kang, Song, Hur, Kim, and Kim: Acute generalized exanthematous pustulosis due to hydroxychloroquine in a rheumatoid arthritis patient

Case Report

Allergy, Asthma & Respiratory Disease 2013; 1(2): 176-178.

Published online: 27 June 2013

DOI: https://doi.org/10.4168/aard.2013.1.2.176

Acute generalized exanthematous pustulosis due to hydroxychloroquine in a rheumatoid arthritis patient

Hye Jin Lim¹, Ji Hye Jung¹, Min Jeoung Kim¹, Jeoung Min Kim¹, Hye Ran Kang¹, Yoon Kyung Song¹, Jin Wuk Hur^1,², Sang-Hoon Kim^1,², Eun Kyung Kim³

¹Department of Internal Medicine, Eulji General Hospital, Seoul, Korea.

²Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea.

³Department 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

Received 11 March 2013 Revised 14 May 2013 Accepted 18 May 2013

(open-access):

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/).

Abstract

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.

Keywords: Acute generalized exanthematous pustulosis, Hydroxychloroquine, Rheumatoid arthritis

Figures and Tables

Fig. 1

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

Fig. 2

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).

References

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