Acute generalised exanthematous pustulosis caused by anti-malarial drug: a case report

Acute generalised exanthematous pustulosis (AGEP) is a severe cutaneous reaction that usually occurs after drug intake. Antimalarials like hydroxychloroquine have long been incriminated in the literature. This is a case of AGEP occurring after the consumption of an antimalarial other than hydroxychloroquine; labeled as Synriam® (piperaquine and arterolane). A 35-year-old Cameroonian woman presented to our outpatient unit for the sudden onset of generalized maculopapular and pustulous pruritic skin eruption, associated with fever (39.5°C). The eruption had started 4 days after the consumption of arterolane and piperaquine drug combination. The patient been living with Takayasu disease and chronic renal failure for 5 years. She had neutrophilia at 10 000/ul, a hypereosinophilia at 1500 /ul, and raised markers of inflammation with and transaminitis. This clinical picture was suggestive of AGEP. The treatment consisted of applying sterile Vaseline and betamethasone 0,05% cream with an antiseptic bath every day. AGEP is a rare but severe cutaneous drug reaction with a female preponderance. The time from drug intake to onset of symptoms and varies from hours to days. The diagnosis is established when a set of clinical, laboratory and histological arguments are available. The management is relatively simple and prevention consists of withdrawing the causal agent. AGEP is a severe cutaneous reaction that can occur after drug intake. Cases of AGEP secondary to antimalarial drug intake other than hydroxychloroquine have not yet been described.