Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
Family Medicine, Universidade Federal do Vale do Sao Francisco, Petrolina, Brazil.
BMJ Case Rep. 2020 Oct 30;13(10):e235846. doi: 10.1136/bcr-2020-235846.
A 23-year-old man with a history of end-stage renal disease was admitted to the hospital due to fever and shock, which occurred during his dialysis. One week prior, he developed an erythematous rash on his chest, face and back, associated with generalised eruption of pustules. In hospital, his status did not improve with norepinephrine and empirical broad-spectrum antibiotics. Following this, methylprednisolone was administered with remarkable improvement. Cultures revealed no infectious aetiology. Based on the morphology of the rash and a compatible skin biopsy, the diagnosis of acute generalised exanthematous pustulosis (AGEP) was established and considered the cause of his shock. The causative agent of his AGEP remained unknown. AGEP is a rare condition, most frequently associated with drug exposure. The removal of the offending agent is the treatment of choice. It can be complicated by shock in rare cases. In that scenario, systemic corticosteroids seem to improve outcomes greatly.
一位 23 岁男性，患有终末期肾病，因发热和休克入院，这些症状是在透析过程中出现的。一周前，他的胸部、面部和背部出现红斑疹，并伴有全身脓疱疹。入院后，去甲肾上腺素和经验性广谱抗生素治疗无效。随后，给予甲基强的松龙治疗，病情显著改善。培养未发现感染病因。根据皮疹形态和相符的皮肤活检，诊断为急性泛发性发疹性脓疱病（AGEP），并认为这是他休克的原因。他的 AGEP 的病因仍不清楚。AGEP 是一种罕见的疾病，最常与药物暴露有关。去除致病药物是首选治疗方法。在罕见情况下，它可能会并发休克。在这种情况下，全身皮质类固醇似乎可以极大地改善预后。
