Bissinger Ingrid, Matute-Turizo Gustavo, Mejía-Barreneche María Natalia
Clínica El Rosario Sede Tesoro. Medellín, Antioquia, Colombia.
Rev Alerg Mex. 2016 Oct-Dec;63(4):408-412. doi: 10.29262/ram.v63i4.173.
Between 62 and 90% of cases of acute generalized exanthematous pustulosis are caused by drugs. Its onset is rapid with generalized pustules, fever, and blood neutrophil count over 7000; pustules resolve spontaneously in less than 15 days. A case associated with piroxicam described.
A 36-year-old with initial erythema of the thorax and abdomen, accompanied by burning, without fever, which later spread to his forearms, upper arms, and thighs, with face edema. A week earlier he had taken piroxicam for low back pain; at the time of hospitalization he received antihistamines, and topical and systemic steroids. Full blood count showed leukocytes at 8920, eosinophils at 600, neutrophils at 6600, total serum IgE at 188 UI, C-reactive protein at 2.9 mg/L, and no liver, kidney, or lung involvement. Treatment was initiated with intravenous antihistamines and ranitidine, saline, topical Vaseline plus topical mupirocin, and systemic steroids. On the second day of hospitalization neutrophils increased to 9000 and PCR to 3.3. The score to evaluate acute exanthematous pustulosis in the patient was 8, giving a definitive diagnosis.
The differential diagnosis should be established primarily with pustular psoriasis. The prognosis is generally good, as reported.
62%至90%的急性泛发性脓疱病病例由药物引起。其起病迅速，伴有全身性脓疱、发热，血液中性粒细胞计数超过7000；脓疱在15天内自行消退。描述了1例与吡罗昔康相关的病例。
一名36岁患者，最初胸部和腹部出现红斑，伴有烧灼感，无发热，随后蔓延至前臂、上臂和大腿，伴有面部水肿。一周前他因腰痛服用了吡罗昔康；住院时接受了抗组胺药、局部和全身类固醇治疗。全血细胞计数显示白细胞8920、嗜酸性粒细胞600、中性粒细胞6600、血清总IgE 188 UI、C反应蛋白为2.9 mg/L，无肝、肾或肺受累。开始采用静脉注射抗组胺药和雷尼替丁、生理盐水、局部凡士林加局部莫匹罗星以及全身类固醇进行治疗。住院第二天中性粒细胞增加到9000，PCR为3.3。评估该患者急性发疹性脓疱病的评分为8分，确诊。
主要应与脓疱型银屑病进行鉴别诊断。如报告所述，预后通常良好。
