A 45-year-old woman presents with fever and numerous small non-follicular pustules on an erythematous base appearing 2 days after starting an antibiotic. Neutrophil count is elevated. Biopsy shows subcorneal pustules with spongiosis. She recovers fully within 2 weeks of stopping the drug. What is the diagnosis?

• A Generalised pustular psoriasis (von Zumbusch)
• B Acute generalised exanthematous pustulosis (AGEP) ✓
• C Drug reaction with eosinophilia and systemic symptoms
• D Stevens-Johnson syndrome

Explanation

AGEP features fever, dozens to hundreds of sterile non-follicular pustules on oedematous erythema within hours to a couple of days of drug exposure, blood neutrophilia, and subcorneal pustules on histology, resolving quickly after drug withdrawal. Aminopenicillins and macrolides are typical culprits. Von Zumbusch pustular psoriasis lacks the tight temporal link to a new drug, DRESS shows eosinophilia with delayed onset, and SJS produces epidermal detachment with mucositis rather than pustules.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.