Acute generalized exanthematous pustulosis in children and adolescents in Singapore: A ten‐year retrospective review
Elis Yuexian Lee, Mark Jean Aan Koh
Abstract
Abstract Background Acute generalized exanthematous pustulosis (AGEP) is a rare, severe, cutaneous adverse reaction. Although most commonly caused by drugs, it can also be triggered by infections, especially in children. Methods This is a retrospective study involving children and adolescents aged 16 years or younger, diagnosed with AGEP between January 2010 and March 2020 in our tertiary pediatric hospital. Information pertaining to the patient's demographics, clinical presentation and progress, biochemical, microbiological, and histopathological investigations, treatment, and outcomes was analyzed. Results Eight patients were diagnosed with AGEP with mean age 8.2 years (range: 1.7‐16.0 years). None of the patients had a personal or family history of psoriasis. Almost all patients had fever (n = 7, 87.5%). Although all 8 patients had intercurrent illness, 5 cases were attributed to infection, while the other 3 were likely precipitated by drugs. Abnormal hematological and biochemical parameters included a raised absolute neutrophil count (mean: 11.5 × 10 9 /L, range: 5.0‐30.9 × 10 9 /L), C‐reactive protein (mean: 52.5 mg/L, range: 5.0‐143.7 mg/L), and erythrocyte sedimentation rate (mean: 38.6 mm/h, range: 6‐64 mm/h). All patients developed post‐pustular desquamation and subsequently recovered. The mean duration from onset to cessation of acute pustulation was 5.6 days (range: 3.0‐10.0 days). One patient developed a recurrent episode of AGEP. Conclusion AGEP is rare and may be more commonly caused by infections in children. The condition is self‐limiting with overall good outcomes in this age‐group. In cases with concomitant infection and drug use, formal allergy testing should be arranged after resolution of the infection to confirm the underlying etiology.