Paracetamol Induced Acute Generalized Exanthematous Pustulosis- A Rare Case Report

Pharmaceutical Science-Pharmacy for Better Health

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a rare cutaneous adverse drug reaction characterized by rapid occurrence of dozens to thousands pinhead-sized, non-follicular, sterile pustular eruptions. AGEP is infrequent with an incidence of one to five millions per year. There are only two previous reports of paracetamol induced AGEP in literature. The clinical course  of  AGEP is characterised by spontaneous resolution on drug withdrawal.  Resolution is marked  by a  characteristic desquamation. Diagnosis of AGEP depends on morphology of skin lesions, presence of fever, laboratory and histopathological findings. Factors that favours the diagnosis of AGEP include onset of pustules within few hours or in few days after the causative agent  is  administered.  The  most  frequent  causative  drugs  are  Aminopenicillins,  ampicillin,  amoxixillin,  sulphonamides, pristinamycin, quinolones, hydroxychloroquine, terbinafin diltiazem. In some cases it is induced by bacterial, viral or parasitic infections. In our case, a 50 year male patient developed multiple pus filled lesions, burning sensations all over the body caused by  administering  paracetamol  drug  where,  the    lesions  desiccated  immediately  after  cessation  of  offending  drug  in  two daysleaving exfoliations .Upon diagnosis the  white blood cell count was increased indicating lymphocytosis. He was administered with antihistamines,  emollients  and corticosteroids  during his course of stay in hospital.  Pustular rashes were reduced and patient recovered with treatment. Paracetamol  is one of the most widely used safer drug worldwide, herein draws special attention that no drug is completely safe hence proper medication history interview would be recommended to overcome the drugs causing adverse drug reactions, that can be possibly dangerous and life threatening.