Mefenamic acid induced Acute Generalized Exanthematous Pustulosis (AGEP): A Case Report
Abstract
Acute Generalized Exanthematous Pustulosis (AGEP) is a rare severe cutaneous adverse reaction mainly caused by drugs. It is characterized by an acute pustular eruption over the body along with fever and leukocytosis. It has been known to resolve spontaneously over a period of 2-3 weeks without long term sequelae. However it is of utmost importance for the physicians to clinically identify this condition as to prevent unwanted extensive management. Mefenamic acid is a non-steroidal antiinflammatory drug (NSAIDs) prescribed over the counter for pain relief. A sixteen year old boy is reported here who developed AGEP after taking mefenamic acid for fever and joint pain. It was diagnosed with the help of history, clinicopathological correlation, AGEP validation score and recovery on withdrawal of the drug. To the best of our knowledge this is the first case report of mefenamic acid causing AGEP in the literature.
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Introduction
Acute Generalized Exanthematous Pustulosis (AGEP) is an immune-mediated severe cutaneous adverse reaction characterized by an acute eruption of sterile non-follicular pinpoint pustules over an erythematous background having predilection of flexural sites such as neck, axilla and inguinal areas. It was first described by Baker and Ryan in 1968 amongst the patients of pustular psoriasis. 1 The term AGEP was given by Beylot in 1980. 2 The incidence of AGEP is estimated to be 1-5 per million per year. 3 In more than 90% cases, drugs are the etiological agents and others are viral infections, insect bites, herbal medicines, mercury ingestion etc. 4
The most commonly implicated drugs include antibiotics (aminopenicillins, macrolides, sulphonamides, fluoroquinolones), anti-malarials like chloroquine and hydroxychloroquine, anti-fungals like terbinafine, diltiazem etc. Roujeau et al 5 and Sidoroff et al 6 in their studies distinguished AGEP from pustular psoriasis and focused mainly on the drugs as etiological agents. A sixteen year old boy is reported here who developed AGEP after taking mefenamic acid for fever and joint pain.
Conclusion
AGEP should be included in the differential diagnosis of patient presenting with pustular skin lesion and history of NSAID intake including mefanamic acid. Clear drug history should be taken as unreported drugs may also cause AGEP.