Faculty of Medicine of Sousse, Department of Pharmacology, University of Sousse, 4000 Sousse, Tunisia.
Department of Dermatology, Farhat Hached University Hospital, 4000 Sousse, Tunisia.
Therapie. 2024 Jul-Aug;79(4):469-474. doi: 10.1016/j.therap.2023.11.011. Epub 2023 Dec 14.
Acute generalized exanthematous pustulosis (AGEP) is a severe and life-threatening cutaneous adverse reaction. Drug-induced AGEP is mainly related to antibiotics. More recently, AGEP following spider bites has been increasingly described. Treatment includes withdrawal of the offending drug and supportive care. In Tunisia, data concerning severe cutaneous adverse reactions (SCARs) in general and especially AGEP is lacking. Herein, we conducted a retrospective study to investigate the epidemiological, clinical characteristics and etiologies of AGEP referred to the Dermatology department. Our study included 32 cases of AGEP. AGEP cases occurred in overall 8.9% of all SCARs referred to the department during the same period study. The majority were females (24 women and 7 men). The median age of the patients was 33 years. A history of psoriasis was reported in 16.1% of patients. All patients presented with an extensive erythematous rash with pinhead pustules. Neutrophil hyperleukocytosis (greater than 7000/mm) was noted in 17 patients (63% of cases). It was associated with hypereosinophilia exceeding 500 elements/mm in 8 cases (29.6%). Drug-induced AGEP was reported in 53% of cases. Antibiotics were implicated in the majority of cases. Delay in onset ranged from 15hours to 7 days, with an average of 2.8 days. A non-drug-induced etiology was considered if the pharmacological investigation was negative, or if a clear non-drug trigger was found. It was retained in ten cases (48.4% of all observations). Spider bites were revealed in 8 cases. AGEP represents a severe, usually drug-related skin reaction. It is classified as a type IVd reaction mediating T cell-related sterile neutrophilic inflammatory response. It typically occurs within 24-48 h of ingestion of the offending drug. Antibiotics are the most common drug family to cause AGEP. Spider bites were involved in 25.8% of cases in our study, as important as antibiotic-induced AGEP. Analysis of the particularities of AGEP according to etiology, whether drug-induced or not, revealed the presence of an initial escarotic lesion (P=0.01) and the finding of blood hypereosinophilia (P=0.014) in the non-drug AGEP group were the distinguishing features. Blood hyperesoniophilia, more frequent in the non-drug AGEP group, suggests a pathophysiology probably different from that of the drug AGEP group. Clinicians should be aware of both etiologies. Our study focuses on the importance of AGEP associated with spider bite as a potential triggering factor in Tunisia.
急性泛发性发疹性脓疱病（AGEP）是一种严重且危及生命的皮肤不良反应。药物引起的 AGEP 主要与抗生素有关。最近，越来越多的蜘蛛咬伤后出现 AGEP 的病例被描述。治疗包括停用致病药物和支持性护理。在突尼斯，有关严重皮肤不良反应（SCAR）的一般数据，尤其是 AGEP 的数据非常缺乏。在此，我们进行了一项回顾性研究，以调查皮肤科就诊的 AGEP 的流行病学、临床特征和病因。我们的研究包括 32 例 AGEP 患者。在同一时期研究中，AGEP 病例占所有 SCAR 患者的 8.9%。大多数是女性（24 名女性和 7 名男性）。患者的中位年龄为 33 岁。16.1%的患者有银屑病病史。所有患者均表现为广泛的红斑性皮疹，伴有粟粒状脓疱。17 例患者（63%的病例）存在中性粒细胞白细胞增多症（大于 7000/mm）。8 例（29.6%）存在嗜酸性粒细胞增多症，超过 500 个/毫米。报告了 53%的药物诱导的 AGEP 病例。大多数情况下，抗生素是引起 AGEP 的原因。发病时间从 15 小时到 7 天不等，平均为 2.8 天。如果药物学研究为阴性，或者发现明确的非药物诱因，则认为是非药物诱导的病因。在 10 例（所有观察到的病例的 48.4%）中保留了该病因。在 8 例中发现了蜘蛛咬伤。AGEP 是一种严重的、通常与药物相关的皮肤反应。它被归类为介导 T 细胞相关无菌性中性粒细胞炎症反应的 IVd 型反应。它通常在摄入致病药物后 24-48 小时内发生。抗生素是最常见引起 AGEP 的药物家族。在我们的研究中，蜘蛛咬伤占病例的 25.8%，与抗生素诱导的 AGEP 一样重要。根据病因（药物或非药物）分析 AGEP 的特殊性，发现非药物性 AGEP 组存在初始疤痕病变（P=0.01）和血液嗜酸性粒细胞增多症（P=0.014）是其特征。非药物性 AGEP 组中更常见的血液嗜酸性粒细胞增多症提示其发病机制可能与药物性 AGEP 组不同。临床医生应注意这两种病因。我们的研究重点是与蜘蛛咬伤相关的 AGEP 作为突尼斯的一个潜在触发因素的重要性。
