Abstract

Background: Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous drug eruption and is usually caused by medication.
Case Presentation: A 23-year-old man had been healthy apart from having atopic dermatitis (AD) since childhood. He presented with a few months’ history of severe flare-up of AD, for which he was treated with cyclosporine 150 mg bid and Augmentin 1 gm bid. One day after initiating cyclosporine and Augmentin, he presented to the emergency department for worsening and new skin lesions. He had no fever. Systemic review was unremarkable. Skin examination showed many new tiny skin lesions that had collarette scales from rupture of pustules and crusts that had formed over his entire body, along with the older, lichenified, AD plaques. A work-up was done for complete blood count, liver function tests, urea, and creatinine, and all were normal. He was diagnosed with AGEP due to the listed findings. Cyclosporine and Augmentin were discontinued, and he was started on etanercept 50 mg SC once weekly. The skin lesions began to resolve a few days after etanercept was started. After the third dose all newly formed skin lesions cleared, and etanercept was stopped. He was then treated with upadacitinib 30 mg tab OD for his AD and had a marked clinical improvement after a few weeks of beginning therapy.
Conclusion: This case highlights AGEP as a potential adverse reaction to amoxicillin-clavulanate in a patient with severe atopic dermatitis and suggests that etanercept may be an effective therapeutic option in selected cases.

Key words: Acute generalized exanthematous pustulosis (AGEP), atopic dermatitis, cyclosporine, etanercept, upadacitinib, drug-induced eruption.