A Rare Presentation of Acute Generalized Exanthematous Pustulosis With Refractory Shock

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction that presents with pustular lesions with underlying edematous and erythematous skin, accompanied by fever, leukocytosis, and neutrophilia. It is characterized by an abrupt onset, usually 24-48 hours after the inciting trigger. The incidence of AGEP is an uncommon skin reaction that is primarily seen in female patients. The clinical course is mostly limited to cutaneous findings, and only in rare cases, systemic involvement can occur. AGEP typically resolves within 1-2 weeks after discontinuation of the offending agent, and topical steroids are used for symptomatic relief. In more severe cases, systemic corticosteroids, vasopressors, or cyclosporine are useful, and vasopressors may be required in cases of circulatory shock. In this case, we present a middle-aged woman with fluid nonresponsive circulatory shock and acute kidney injury secondary to an uncommon presentation of AGEP, confirmed by histopathologic findings.