Zhang Liangliang, Xu Qiuyun, Lin Tingting, Ruan Shifan, Lin Mengting, Bao Chengbei, Zhang Jing, Liu Tao, Gong Ting, Ji Chao
Department of Dermatology, The First Hospital of Fujian Medical University, Fuzhou, China.
Department of Medical Affairs, Beijing Novartis Pharma Company Limited, Shanghai, China.
Front Med (Lausanne). 2021 Dec 16;8:758354. doi: 10.3389/fmed.2021.758354. eCollection 2021.
Acute generalized exanthematous pustulosis is a severe, usually drug-related reaction, characterized by an acute onset of mainly small non-follicular pustules on an erythematous base. Most cases of acute generalized exanthematous pustulosis (AGEP) clear quickly with a systemic corticosteroid, but severe or recalcitrant cases may need other systemic therapies. In this case, a man in his 40 s with a history of psoriasis consulted a physician about widespread erythema, pustules, target lesions, and fever after the administration of a quadruple antituberculosis drug. Routine laboratory testing revealed elevated white blood cell count and C-reactive protein. The histopathology showed subcorneal pustules, spongiosis as well as lymphocyte and eosinophils infiltration in the dermis. The patient was diagnosed with definitive AGEP according to the diagnostic score from the EuroSCAR study. Cutaneous lesions especially pustules and erythema multiforme-like lesions on the upper arms and palms are crucial for distinguishing AGEP from Generalized pustular psoriasis. The patient was treated with secukinumab as a result of his failure to respond to topical corticosteroids and constrain of systemic steroids. Remission with secukinumab therapy was safe without increased risks of infections. This case indicates that secukinumab is a potential therapy that can rapidly improve the clinical symptoms of AGEP.
急性泛发性脓疱病是一种严重的、通常与药物相关的反应，其特征为急性起病，主要在红斑基础上出现小的非毛囊性脓疱。大多数急性泛发性脓疱病（AGEP）病例使用全身性糖皮质激素后可迅速消退，但严重或难治性病例可能需要其他全身性治疗。在本病例中，一名40多岁有银屑病病史的男性在服用四联抗结核药物后，因广泛的红斑、脓疱、靶形损害和发热而咨询医生。常规实验室检查显示白细胞计数和C反应蛋白升高。组织病理学显示角层下脓疱、海绵形成以及真皮层淋巴细胞和嗜酸性粒细胞浸润。根据欧洲严重药物不良反应研究（EuroSCAR）的诊断评分，该患者被确诊为明确的AGEP。皮肤损害，尤其是上臂和手掌上的脓疱及多形红斑样损害，对于区分AGEP和泛发性脓疱型银屑病至关重要。由于该患者对外用糖皮质激素无反应且全身性糖皮质激素受限，因此接受司库奇尤单抗治疗。司库奇尤单抗治疗缓解安全，未增加感染风险。该病例表明司库奇尤单抗是一种可迅速改善AGEP临床症状的潜在治疗方法。
