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AGEP — SCE Dermatology MCQ

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ModerateDrug ReactionsAGEPSCE Dermatology

A 36-year-old woman presents with a sudden eruption of widespread sterile pustules on a diffuse erythematous background, fever, and leucocytosis with neutrophilia. She started Amoxicillin 3 days ago for a urinary tract infection. Biopsy shows spongiform subcorneal pustules with papillary dermal oedema. What is the most likely diagnosis?

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Correct answer: C — Acute generalised exanthematous pustulosis (AGEP)

The correct answer is C, Acute generalised exanthematous pustulosis (AGEP). This patient has the classic triad of an acute drug-induced pustular eruption: rapid onset of widespread sterile, non-follicular pustules on diffuse erythema, fever, and neutrophilic leucocytosis, beginning within days of starting a beta-lactam antibiotic. Beta-lactams, particularly aminopenicillins such as amoxicillin, are the most frequently implicated trigger for this reaction pattern. The biopsy findings of spongiform subcorneal pustules with papillary dermal oedema are histologically characteristic of AGEP and support the diagnosis over its main differential, generalised pustular psoriasis. Management is prompt withdrawal of the causative drug, with spontaneous resolution typically within one to two weeks.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions