Alzahrani Malak J, Moussa Mohamed M, Alfaraj Dunya
Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
Emergency Department, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
Cureus. 2020 Nov 21;12(11):e11609. doi: 10.7759/cureus.11609.
There is a dearth of robust evidence regarding coronavirus disease 2019 (COVID-19)-related coetaneous manifestations, complications and adverse treatment events. Upon review of the literature there are only a few cases reported of acute generalized exanthematous pustulosis (AGEP) in COVID-19 patients after treatment. Therefore, we are reporting a case of a 34-year-old male not known to have any chronic illness. His severe COVID-19 infection resolved four days prior to presentation to the Emergency Department with pustular rash on erythematous base over his face, neck, upper limbs, anterior and posterior trunk including oral cavity and tounge. The rash started after he took azithromycin, oseltamivir, ribavirin, lopinavir, hydroxychloroquine, prednisolone, ceftriaxone, clindamycin, interferon (IFN) beta, and ceftazidime for COVID-19. Skin punch biopsy was done and he was diagnosed with AGEP but it was still not known if it was related to COVID-19 or a drug-induced condition. Patient was treated with betamethasone valerate 0.1% ointment and lotion, promethazine hydrochloride 25mg tablet, paracetamol 500mg tablet, calcipotriol 50mcg/g and betamethasone 0.5mg/g gel. He discharged the same day to manage at home despite not improving. In the end, we found only a few studies that describe the cutaneous manifestations of COVID-19 infection, which were mainly case reports. We can't be sure that AGEP is a late and severe complication of COVID-19 infection. However, AGEP could be a rare adverse effect of hydroxychloroquine therapy. Improving the knowledge about a wide range of different signs and symptoms of the disease and its severity in addition to all possible adverse treatment events and complications can improve patient safety, survival rate, and quality of life.
关于2019冠状病毒病（COVID-19）相关的同时出现的表现、并发症及不良治疗事件，目前缺乏有力证据。查阅文献后发现，仅有少数关于COVID-19患者治疗后出现急性泛发性脓疱性皮病（AGEP）的病例报告。因此，我们报告一例34岁男性病例，该患者无任何慢性病病史。他的重症COVID-19感染在前往急诊科就诊前四天已缓解，当时其面部、颈部、上肢、躯干前后包括口腔和舌头出现了以红斑为基底的脓疱性皮疹。皮疹在他因COVID-19服用阿奇霉素、奥司他韦、利巴韦林、洛匹那韦、羟氯喹、泼尼松龙、头孢曲松、克林霉素、干扰素（IFN）β和头孢他啶后开始出现。进行了皮肤打孔活检，他被诊断为AGEP，但仍不清楚这是与COVID-19相关还是药物引起的病症。患者接受了0.1%戊酸倍他米松软膏和洗剂、25mg盐酸异丙嗪片、500mg对乙酰氨基酚片、50mcg/g骨化三醇和0.5mg/g倍他米松凝胶治疗。尽管病情未改善，他仍于当天出院回家管理。最后，我们发现仅有少数研究描述了COVID-19感染的皮肤表现，且主要是病例报告。我们无法确定AGEP是COVID-19感染的晚期严重并发症。然而，AGEP可能是羟氯喹治疗的罕见不良反应。除了所有可能的不良治疗事件和并发症外，提高对该疾病广泛的不同体征和症状及其严重程度的认识，可以提高患者安全性、生存率和生活质量。
