College of Pharmacy, Changsha Medical University, Changsha, 410219, Hunan, China.
Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, 410219, Hunan, China.
Arch Dermatol Res. 2024 Aug 24;316(8):573. doi: 10.1007/s00403-024-03310-8.
Acute generalized exanthematous pustulosis (AGEP) is a serious and rare adverse reaction to clindamycin. This study investigated the clinical features of clindamycin-induced AGEP and provided reference for the prevention and treatment of AGEP. Case reports, case series and clinical studies of clindamycin-induced AGEP were collected by retrieving English and Chinese database from inception until May 31, 2024. Of the 35 patients included, 25 (71.4%) were female, and the median age was 57 years (1.6-88 years). The duration of AGEP onset is 2 days (range 0.04,13) after initial administration. The main clinical morphology of AGEP is a non-follicular pustular on an erythematous base, which may be accompanied by fever (54.3%) and pruritus (40.0%). These lesions mainly involved extremities and trunk. The median elevated neutrophil count was 13.3 × 10/L (range 10.3, 31.4). Histologic features of AGEP are characterized by intracorneal, subcorneal, and/or intraepidermal pustules with papillary dermal edema containing neutrophilic, lymphocytic, andeosinophilic infiltrates. Patients gradually recovered after the withdrawal of clindamycin and supportive therapy with a median time of 9 days (range 2, 30). Clinicians should be aware of AGEP as a rare adverse effect of clindamycin. When clindamycin is prescribed, it should be stopped in time when AGEP occurs, and active systemic treatment should be given. AGEP is a self-limiting disease with a good prognosis.
急性泛发性发疹性脓疱病（AGEP）是克林霉素严重且罕见的不良反应。本研究调查了克林霉素诱导的 AGEP 的临床特征，为 AGEP 的预防和治疗提供了参考。通过检索从建库至 2024 年 5 月 31 日的英文和中文数据库，收集了克林霉素诱导的 AGEP 的病例报告、病例系列和临床研究。纳入的 35 例患者中，25 例（71.4%）为女性，中位年龄为 57 岁（1.6-88 岁）。AGEP 发病时间为初始给药后 2 天（范围 0.04，13）。AGEP 的主要临床形态为红斑基础上的非滤泡性脓疱，可能伴有发热（54.3%）和瘙痒（40.0%）。这些病变主要累及四肢和躯干。中位升高的中性粒细胞计数为 13.3×10/L（范围 10.3，31.4）。AGEP 的组织学特征是棘层内、棘层下和/或表皮内脓疱，伴有乳头状真皮水肿，包含中性粒细胞、淋巴细胞和嗜酸性粒细胞浸润。患者在停用克林霉素和支持治疗后逐渐恢复，中位时间为 9 天（范围 2，30）。临床医生应意识到 AGEP 是克林霉素的一种罕见不良反应。当发生 AGEP 时，应及时停用克林霉素，并给予积极的全身治疗。AGEP 是一种自限性疾病，预后良好。
