Ntavari Niki, Mavrovounis Georgios, Gravani Agoritsa, Syrmou Vasiliki, Roussaki Angeliki-Viktoria, Zafiriou Efterpi, Pantazopoulos Ioannis
J Emerg Nurs. 2025 Jan;51(1):20-26. doi: 10.1016/j.jen.2024.08.005.
Acute generalized exanthematous pustulosis is a severe cutaneous adverse reaction characterized by the rapid onset of nonfollicular, sterile pustules on an erythematous base, typically accompanied by fever (≥38 °C), neutrophilia (7.0 × 10⁹/L), and characteristic histopathological features. This case report presents the first documented instance of acute generalized exanthematous pustulosis after hyaluronic acid viscosupplementation. A 61-year-old female developed a pruritic, erythematous rash that rapidly evolved into generalized erythroderma with systemic manifestations after receiving intra-articular hyaluronic acid injections for knee osteoarthritis. Initial physical examination and diagnostic workup, including biopsy and blood tests, were performed to exclude other differential diagnoses such as generalized pustular psoriasis, subcorneal pustular dermatosis, and immunoglobulin A pemphigus. The temporal association with hyaluronic acid injections and the patient's positive response to treatment with systemic corticosteroids and antihistamines supported the definitive diagnosis of drug-induced acute generalized exanthematous pustulosis. The patient was managed with the withdrawal of the offending agent, and supportive care was provided. She did not require rehabilitation and experienced no adverse events during the recovery period. Follow-up visits confirmed the absence of recurrence and complete resolution of symptoms, with no lasting sequelae. This case underscores the importance of recognizing acute generalized exanthematous pustulosis' acute manifestations and potential triggers, even with treatments generally considered safe. ED personnel, including advanced practice registered nurses and other clinicians, must include acute generalized exanthematous pustulosis in their differential diagnoses of severe cutaneous disorders to initiate prompt and appropriate management. The development of atrial fibrillation during hospitalization in this patient raises questions about the systemic effects of acute generalized exanthematous pustulosis, suggesting an area for further research. Early detection and treatment of acute generalized exanthematous pustulosis are crucial for favorable outcomes, illustrating the vital role ED personnel play in managing this condition. Awareness of rare triggers such as hyaluronic acid is essential for preventing and effectively treating such severe adverse reactions.
急性泛发性发疹性脓疱病是一种严重的皮肤不良反应，其特征为在红斑基础上迅速出现非毛囊性无菌脓疱，通常伴有发热（≥38°C）、中性粒细胞增多（7.0×10⁹/L）以及特征性组织病理学特征。本病例报告展示了首例有记录的透明质酸粘弹补充术后发生急性泛发性发疹性脓疱病的病例。一名61岁女性在接受膝关节骨关节炎关节内注射透明质酸后，出现瘙痒性红斑皮疹，迅速发展为伴有全身症状的全身性红皮病。进行了初步体格检查和诊断性检查，包括活检和血液检查，以排除其他鉴别诊断，如泛发性脓疱型银屑病、角层下脓疱性皮肤病和免疫球蛋白A天疱疮。与透明质酸注射的时间关联以及患者对全身用皮质类固醇和抗组胺药治疗的阳性反应支持了药物性急性泛发性发疹性脓疱病的明确诊断。患者停用致病药物并给予支持性治疗。她无需康复治疗，恢复期未出现不良事件。随访证实无复发且症状完全缓解，无持久后遗症。本病例强调了认识急性泛发性发疹性脓疱病的急性表现和潜在触发因素的重要性，即使是对于通常被认为安全的治疗方法。包括高级执业注册护士和其他临床医生在内的急诊科工作人员在对严重皮肤疾病进行鉴别诊断时，必须将急性泛发性发疹性脓疱病纳入考虑，以便启动及时、恰当的管理。该患者住院期间发生心房颤动，引发了关于急性泛发性发疹性脓疱病全身影响的疑问，提示这是一个有待进一步研究的领域。急性泛发性发疹性脓疱病的早期检测和治疗对于取得良好预后至关重要，这说明了急诊科工作人员在管理这种疾病中所起的关键作用。认识到如透明质酸等罕见触发因素对于预防和有效治疗此类严重不良反应至关重要。
