Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3578-3582
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3578
Acute generalized exanthematous pustulosis with airway mucosa involvement: A case report
Lu-Lu Li, Yuan-Qiang Lu, Tong Li
Lu-Lu Li, Yuan-Qiang Lu, Tong Li, Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Li LL was involved in data curation, provision of resources, investigation and writing of the original draft; Li T performed data curation and formal analysis, participated in the investigation, project administration, methodology design, software utilization, data visualization, writing, reviewing and editing of the manuscript; Lu YQ took part in the provision of resources, supervision of the study, reviewing and editing of the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tong Li, MD, PhD, Chief Physician, Department of Emergency Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. drli@mail.zju.edu.cn
Received: March 9, 2020
Peer-review started: March 9, 2020
First decision: June 18, 2020
Revised: June 26, 2020
Accepted: July 15, 2020
Article in press: July 15, 2020
Published online: August 26, 2020
Processing time: 169 Days and 5.4 Hours
Abstract
BACKGROUND

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by sterile pustules on erythematous skin associated with fever and leukocytosis. The annual incidence of AGEP is estimated to be 1-5 cases per million. Cases of AGEP with oral mucosa involvement have been reported. However, reports of AGEP involving airway mucosa are limited.

CASE SUMMARY

We report a 42-year-old woman with serious AGEP involving the airway mucosa. The patient initially developed fever and a small rash on her forehead and face. Over the next 2 d, she developed a diffuse, pustular rash over her trunk and legs. In addition, she complained of a cough with white foam-like sputum, chest tightness and dyspnea. Four days later, due to dyspnea, her mental status started to gradually deteriorate. She became more and more drowsy. Biopsies of the skin and airway mucosa suggested the diagnosis of AGEP. According to the European study of severe cutaneous adverse reactions group’s scoring system, the patient scored +6 indicating a probable diagnosis of AGEP. She received intravenous methylprednisolone 120 mg/12 h for 3 d, and was eventually discharged in good condition. This patient had already experienced respiratory failure and airway mucosa involvement on admission; however, the clinicians had an insufficient understanding of AGEP. Glucocorticoid was administered for more than 10 d following onset of the disease, and her overall prognosis was satisfactory.

CONCLUSION

This case represents a rare clinical feature of AGEP and an important finding for clinicians.

Keywords: Acute generalized exanthematous pustulosis; Airway mucosa; Traditional Chinese medicine; Heavy metals; Case report

Core tip: Acute generalized exanthematous pustulosis (AGEP) is a rare dermatologic reaction characterized by an erythematous rash with fever, leukocytosis and pustular erosions. We report a 42-year-old Chinese woman who developed serious AGEP involving the airway mucosa. Following treatment with intravenous methylprednisolone, the patient was eventually discharged in good condition. This case represents a rare clinical feature of AGEP and an important finding for clinicians.