Pustulosis exantemática generalizada aguda inducida por hidroxicloroquina
Palabras clave:
pustulosis exantemática generalizada aguda, efectos colaterales y reacciones adversas relacionados con medicamentos, hidroxicloroquina
Resumen
La pustulosis exantemática generalizada aguda (PEGA) es una reacción cutánea poco común caracterizada por la presencia de pústulas estériles sobre una base eritematosa, generalmente asociada a fármacos. Presentamos el caso de una paciente femenina, de 56 años, quien desarrolló un cuadro clínico dermatológico consistente en aparición de lesiones pustulosas en cuero cabelludo, cara, extremidades y genitales, acompañadas de prurito y fiebre tras 22 días de tratamiento con 200 mg/día de hidroxicloroquina para manejo de síndrome de Sjögren. Inicialmente se diagnosticó como varicela. Sin embargo, al persistir las lesiones y la fiebre, se realizó una evaluación dermatológica que condujo al diagnóstico de PEGA inducida por hidroxicloroquina.
Citas
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14. Cortese A, Pancetti S, Pressiani T, Toso F, Fiorillo G, Costanzo A, Borroni RG. Sorafenib-induced acute generalized exanthematous pustulosis. Dermatol Pract Concept [Internet]. 2023 [cited 2024 Jun 17];13(2): e2023130. Available from: https://pubmed.ncbi.nlm.nih.gov/37196299. doi: 10.5826/dpc.1302a130
15. Hsieh ChH, Yao ChA, Lo Y. Acute generalized exanthematous pustulosis induced by hydroxychloroquine. Kaohsiung J Med Sci [Internet]. 2021 [cited 2024 Jun 17];37(12):1122–3. Available from: https://pubmed.ncbi.nlm.nih.gov/34390130. doi: 10.1002/kjm2.12439
16. Litaiem N, Hajlaoui K, Karray M, Slouma M, Zeglaoui F. Acute generalized exanthematous pustulosis after COVID-19 treatment with hydroxychloroquine. Dermatol Ther [Internet]. 2020 [cited 2024 Jun 17];33(4): e13565. Available from: https://pubmed.ncbi.nlm.nih.gov/32401410. doi: 10.1111/dth.13565
2. Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, Dodiuk-Gad RP. Acute generalized exanthematous pustulosis: Clinical features, differential diagnosis, and management. Am J Clin Dermatol [Internet]. 2023 [cited 2024 Jun 17];24(4):557–75. Available from: https://pubmed.ncbi.nlm.nih.gov/37156992. doi: 10.1007/s40257-023-00779-3
3. Lang X, Bi H, Zhang Y, Cui H, Liu H, Ren L, et al. Case report: Post-streptococcal pustulosis after subcutaneous injection of secukinumab. Front Med (Lausanne) [Internet]. 2023 [cited 2024 Jun 17];10: 1217545. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10342198. doi: 10.3389/fmed.2023.1217545
4. Feldmeyer L, Heidemeyer K, Yawalkar N. Acute generalized exanthematous pustulosis: Pathogenesis, genetic background, clinical variants and therapy. Int J Mol Sci [Internet]. 2016 [cited 2024Jun 17];17(8). Available from: https://pubmed.ncbi.nlm.nih.gov/27472323. doi: 10.3390/ijms17081214
5. Luo F, Yuan XM, Xiong H, Yang YZ, Chen ChM, Ma WK, Yao XM. Clinical features of acute generalized exanthematous pustulosis caused by hydroxychloroquine in rheumatology patients and exploration of CARD14 gene mutations. Front Med (Lausanne) [Internet]. 2023 [cited 2024 Jun 17];10: 1161837. Available from: https://pubmed.ncbi.nlm.nih.gov/37089611. doi: 10.3389/fmed.2023.1161837
6. Oh DAQ, Yeo YW, Choo KJL, Pang SM, Oh ChCh, Lee HY. Acute generalized exanthematous pustulosis: Epidemiology, clinical course, and treatment outcomes of patients treated in an Asian academic medical center. JAAD Int [Internet]. 2021 [cited 2024 Jun 17]; 3:1–6. Available from: https://pubmed.ncbi.nlm.nih.gov/34409363. doi: 10.1016/j.jdin.2020.12.004
7. Halevy S, Kardaun SH, Davidovici B, Wechsler J. The spectrum of histopathological features in acute generalized exanthematous pustulosis: A study of 102 cases. Br J Dermatol. 2010;163(6):1245–52. doi:10.1111/j.1365-2133.2010. 09967.x
8. Nili A, Zarei E, Ghamari A, Farid AS, Tavakolpour S, Daneshpazhooh M, Mahmoudi H. Acute generalized exanthematous pustulosis with a focus on hydroxychloroquine: A 10-year experience in a skin hospital. Int Immunopharmacol [Internet]. 2020 [cited 2024 Jun 17];89(Pt B):107093. Available from: https://pubmed.ncbi.nlm.nih.gov/33091817. doi: 10.1016/j.intimp.2020.107093
9. Mofarrah R, Mofarrah R, Oshriehye M, Ghobadi Aski S, Nazemi N, Nooshiravanpoor P. The necessity of patch testing in determining the causative drug of AGEP. J Cosmet Dermatol [Internet]. 2021 [cited 2024 Jun 17];20(7):2156–9. Available from: https://pubmed.ncbi.nlm.nih.gov/33190407. doi: 10.1111/jocd.13841
10. Vallejo-Yagüe E, Martinez-De la Torre A, Mohamad OS, Sabu S, Burden AM. Drug triggers and clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A literature case series of 297 patients. J Clin Med [Internet]. 2022 [cited 2024 Jun 17];11(2):397. Available from: https://pubmed.ncbi.nlm.nih.gov/35054090. doi: 10.3390/jcm11020397
11. Sussman M, Napodano A, Huang S, Are A, Hsu S, Motaparthi K. Pustular psoriasis and acute generalized exanthematous pustulosis. Medicina (Kaunas) [Internet]. 2021 [cited 2024 Jun 17];57(10) :1004. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8538083. doi: 10.3390/medicina57101004
12. Coleman I, Ruiz G, Brahmbhatt S, Ackerman L. Acute generalized exanthematous pustulosis and Stevens-Johnson syndrome overlap due to hydroxychloroquine: a case report. J Med Case Rep [Internet]. 2020 [cited 2024 Jun 17];14(1):210. Available from: https://pubmed.ncbi.nlm.nih.gov/33138853. doi: 10.1186/s13256-020-02504-8
13. Odorici G, Schenetti C, Pacetti L, Schettini N, Gaban A, Mantovani L. Acute generalized exanthematous pustulosis due to hydroxichloroquine. Dermatol Ther [Internet]. 2022 [cited 2024 Jun 17];35(7): e15520. Available from: https://pubmed.ncbi.nlm.nih.gov/35434875. doi: 10.1111/dth.15520
14. Cortese A, Pancetti S, Pressiani T, Toso F, Fiorillo G, Costanzo A, Borroni RG. Sorafenib-induced acute generalized exanthematous pustulosis. Dermatol Pract Concept [Internet]. 2023 [cited 2024 Jun 17];13(2): e2023130. Available from: https://pubmed.ncbi.nlm.nih.gov/37196299. doi: 10.5826/dpc.1302a130
15. Hsieh ChH, Yao ChA, Lo Y. Acute generalized exanthematous pustulosis induced by hydroxychloroquine. Kaohsiung J Med Sci [Internet]. 2021 [cited 2024 Jun 17];37(12):1122–3. Available from: https://pubmed.ncbi.nlm.nih.gov/34390130. doi: 10.1002/kjm2.12439
16. Litaiem N, Hajlaoui K, Karray M, Slouma M, Zeglaoui F. Acute generalized exanthematous pustulosis after COVID-19 treatment with hydroxychloroquine. Dermatol Ther [Internet]. 2020 [cited 2024 Jun 17];33(4): e13565. Available from: https://pubmed.ncbi.nlm.nih.gov/32401410. doi: 10.1111/dth.13565
