Allergy, Asthma & Respiratory Disease

The Korean Academy of Asthma, Allergy and Clinical Immunology (대한천식알레르기학회)
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A Stevens-Johnson syndrome and acute generalized exanthematous pustulosis overlap caused by antibiotics: A case report

항생제로 인한 스티븐스-존슨증후군과 급성 전신성 발진성 농포증이 중첩으로 나타난 1예와 문헌고찰

  • Myung Pyo Kim (Department of Pulmonology, Gangneung Asan Hospital) ;
  • Yeo Un Lee (Department of Pharmaceuticals, Gangneung Asan Hospital) ;
  • Sya Ron Lim (Department of Pathology, Gangneung Asan Hospital) ;
  • Yeong Sang Yoo (Department of Allergy, Gangneung Asan Hospital)
  • 김명표 (강릉아산병원 호흡기내과) ;
  • 이여운 (강릉아산병원 약제과) ;
  • 임샤론 (강릉아산병원 병리과) ;
  • 유영상 (강릉아산병원 알레르기내과)
  • Received : 2023.11.03
  • Accepted : 2024.01.04
  • Published : 2024.10.30
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Abstract

Stevens-Johnson syndrome (SJS) and acute generalized exanthematous pustulosis (AGEP) are 2 distinct entities that can overlap within the spectrum of severe cutaneous adverse reaction (SCAR). AGEP is a self-limiting and drug-induced eruption characterized by sudden onset of sterile pustules, erythema, and sometimes fever. SJS, in contrast, is a severe form of SCAR that causes blistering and necrosis of the skin and mucosal membranes, often leading to significant morbidity and mortality. However, there are cases where patients may present with symptoms that overlap between AGEP and SJS, making it challenging to differentiate the 2 conditions. This report describes a 70-year-old male with nontuberculous mycobacterium tenosynovitis in the left hand, coinfected with methicillin-resistant coagulase-negative Staphylococcus and Klebsiella oxytoca. After administration of additional antibiotics, the patient developed fever and erythematous macules with purpuric centers on the trunk and the extremities. Further examination revealed marked leukocytosis and elevated C-reactive protein levels. Skin biopsy histopathology showed subcorneal intraepidermal pustule formation with neutrophil infiltration. The patient's clinical course improved after cessation of the culprit drugs and treatment with a high-dose systemic steroid. This case highlights the rare occurrence of SJS/AGEP overlap and underscores the importance of prompt diagnosis and appropriate management of these SCAR.

Keywords

References

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