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Case report
Acute generalised exanthematous pustulosis associated with shock
  1. Philippos Apolinario Costa1,
  2. Bruna Menon Loureiro Apolinario Costa2,
  3. Clara Milikowski3 and
  4. Joan E St Onge1
  1. 1Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
  2. 2Family Medicine, Universidade Federal do Vale do Sao Francisco, Petrolina, Brazil
  3. 3Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Philippos Apolinario Costa; philippos500ac{at}


A 23-year-old man with a history of end-stage renal disease was admitted to the hospital due to fever and shock, which occurred during his dialysis. One week prior, he developed an erythematous rash on his chest, face and back, associated with generalised eruption of pustules. In hospital, his status did not improve with norepinephrine and empirical broad-spectrum antibiotics. Following this, methylprednisolone was administered with remarkable improvement. Cultures revealed no infectious aetiology. Based on the morphology of the rash and a compatible skin biopsy, the diagnosis of acute generalised exanthematous pustulosis (AGEP) was established and considered the cause of his shock. The causative agent of his AGEP remained unknown. AGEP is a rare condition, most frequently associated with drug exposure. The removal of the offending agent is the treatment of choice. It can be complicated by shock in rare cases. In that scenario, systemic corticosteroids seem to improve outcomes greatly.

  • drugs and medicines
  • skin
  • unwanted effects / adverse reactions

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  • Contributors PAC and BMLAC conceptualised and wrote the manuscript. CM revised, provided pathological images and edited the manuscript. JESO supervised the work as a senior author, revised and edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.