Lee Elis Yuexian, Koh Mark Jean Aan
Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Dermatology Service, KK Women's and Children's Hospital, Singapore.
Pediatr Dermatol. 2021 Mar;38(2):424-430. doi: 10.1111/pde.14482. Epub 2020 Dec 18.
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.
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.
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 /L, range: 5.0-30.9 × 10 /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.
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.
急性泛发性脓疱病（AGEP）是一种罕见的严重皮肤不良反应。虽然最常见由药物引起，但也可由感染引发，尤其是在儿童中。
这是一项回顾性研究，纳入了16岁及以下于2010年1月至2020年3月在我们的三级儿科医院被诊断为AGEP的儿童和青少年。分析了有关患者人口统计学、临床表现及病情进展、生化、微生物学和组织病理学检查、治疗及结果的信息。
8例患者被诊断为AGEP，平均年龄8.2岁（范围：1.7 - 16.0岁）。所有患者均无银屑病个人史或家族史。几乎所有患者都有发热（n = 7，87.5%）。虽然所有8例患者都有并发疾病，但5例归因于感染，另外3例可能由药物诱发。血液学和生化参数异常包括绝对中性粒细胞计数升高（平均：11.5×10⁹/L，范围：5.0 - 30.9×10⁹/L）、C反应蛋白（平均：52.5mg/L，范围：5.0 - 143.7mg/L）和红细胞沉降率（平均：38.6mm/h，范围：6 - 64mm/h）。所有患者均出现脓疱后脱皮，随后康复。急性脓疱发作开始至停止的平均持续时间为5.6天（范围：3.0 - 10.0天）。1例患者出现AGEP复发。
AGEP罕见，在儿童中可能更常见由感染引起。该病具有自限性，在这个年龄组总体预后良好。对于伴有感染和使用药物的病例，感染消退后应安排正式的过敏测试以确认潜在病因。
