Lei Haibo, Deng Hongyi, Liu Xiang, Li Zuojun, Wang Chunjiang
Department of Clinical Pharmacy, Xiangtan Central Hospital, Xiangtan, Hunan, China.
Department of Pharmacy, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
J Clin Pharm Ther. 2022 Dec;47(12):2008-2013. doi: 10.1111/jcpt.13738. Epub 2022 Jul 31.
Acute generalized exanthematous pustulosis (AGEP) is a serious and rare adverse reaction of cephalosporins. We aimed to describe the clinical features of cephalosporin-induced AGEP and provide a reference for rational clinical use of cephalosporins.
We systematically searched Chinese and English databases for cephalosporin-induced TGEP-related case reports, retrospective studies, clinical studies, and review articles published before May 2022.
A total of 43 patients from 35 articles were eligible, of which 28 (65.1%) were female, with a median age of 69 years. A total of 11 cephalosporins were suspected, the most commonly involved were ceftriaxone (41.9%), cephalexin (16.3%), and cefepime (9.3%). AEGP erupted primarily within 14 days after administration, manifested as nonfollicular pustules on an erythematous base, distributed favourably to the extremities (44.2%), trunk (23.3%), face (23.3%), and could involve the oral mucosa (11.6%). During AGEP resolution, the affected area had desquamation (39.5%). The acute phase of the disease may be accompanied by fever (>38.0°C) and elevated neutrophil count (>7500/mm ). Histology of AGEP showed subcorneal pustules (56.3%), intraepidermal cavernous pustules (37.5%), with papillary dermal edema (37.5%), containing neutrophils and eosinophilic infiltration (71.9%). After drug discontinuation, the median time to resolution of AGEP symptoms was 10 days (range 2, 90).
Cephalosporin-induced AGEP is rare and should be properly diagnosed. This serious cutaneous adverse reaction is self-limiting and has a favourable prognosis, usually resolves with drug interruption, and may require additional interventions, such as topical steroids.
急性泛发性脓疱性皮病（AGEP）是头孢菌素类药物一种严重且罕见的不良反应。我们旨在描述头孢菌素诱发的AGEP的临床特征，并为临床合理使用头孢菌素提供参考。
我们系统检索了中英文数据库，查找2022年5月之前发表的与头孢菌素诱发的AGEP相关的病例报告、回顾性研究、临床研究及综述文章。
35篇文章中共纳入43例患者，其中女性28例（65.1%），中位年龄69岁。共怀疑11种头孢菌素类药物，最常涉及的是头孢曲松（41.9%）、头孢氨苄（16.3%）和头孢吡肟（9.3%）。AGEP主要在用药后14天内发作，表现为红斑基础上的非毛囊性脓疱，好发于四肢（44.2%）、躯干（23.3%）、面部（23.3%），可累及口腔黏膜（11.6%）。在AGEP消退过程中，受累部位有脱屑（39.5%）。疾病急性期可能伴有发热（>38.0°C）和中性粒细胞计数升高（>7500/mm）。AGEP的组织学表现为角层下脓疱（56.3%）、表皮内海绵状脓疱（37.5%），伴有乳头真皮水肿（37.5%），有中性粒细胞和嗜酸性粒细胞浸润（71.9%）。停药后，AGEP症状消退的中位时间为10天（范围2至90天）。
头孢菌素诱发的AGEP罕见，应正确诊断。这种严重的皮肤不良反应是自限性的，预后良好，通常停药后可缓解，可能需要额外干预，如外用类固醇。
