AGEP Caused by Macrolide: A Case Report

Background Acute generalized exanthematous pustulosis (AGEP) is a severe skin reaction characterized by rash with multiple and sterile pustules. It is triggered mostly by drugs. We report the case of a woman with AGEP induced by clarithromycin. Case History A 57 yo woman with a history of post-surgical hypothyroidism was admitted to our hospital for a systemic skin rash with pustules. Five days before admission due to the onset of fever she started clarithromycin 500 mg bd and after 24–48 h of ingestion of this drug, she presented cutaneous adverse reaction. The patient was prescribed topical steroids, antipyretics, and antihistamines. Infection diseases, included viral and bacterial, cancer and autoimmune disease were excluded. A biopsy cutaneous lesion on the right gluteal region was performed. The histopathological findings showed spongiform pustules with perivascular lymphocytes and neutrophils infiltrated compatible with AGEP. Due the severe presentation, oral corticosteroids were used with improvement of cutaneous manifestations and reduction in length of hospital stay and morbidity. Discussion AGEP is a severe cutaneous adverse reaction associated with various medications, including macrolide antibiotics such as clarithromycin. Prompt recognition and management are essential to mitigate potential complications and ensure favorable outcomes for affected patients.