Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Resident
Discipline/Specialty (Author 2)
Internal Medicine
Discipline Track
Clinical Science
Abstract
Background We present a patient who developed pustular rash following levofloxacin use. Acute generalized exanthematous pustulosis is a rare drug reaction. This abstract will review the patient’s symptoms, diagnosis and management.
Case presentation 25-year-old man presented with fever, facial swelling, and pruritic rash on face and body of a day duration. Two days prior, he had been prescribed levofloxacin for a sore throat. His symptoms developed within 24 hours of his first use of levofloxacin. He denied previous use of levofloxacin. His vital signs were T 101.7, RR 18, HR 114, BP 112/59, SPO2 100% on RA. On examination, he had pustular rash overlying edematous and erythematous skin on his face and abdomen. He also had facial and lip swelling. Other physical examination findings were within normal limit. Significant lab report showed WBC 21,120/mm3 with neutrophil count 18000/mm3, lactic acid 2.07, and ALT 67. Acute generalized exanthematous pustulosis was diagnosed presumptively. His levofloxacin was discontinued. He was given diphenhydramine and dexamethasone. His facial swelling resolved, his leucocytosis improved, and his rash improved remarkedly and became non-pruritic. He was discharged on topical corticosteroid therapy.
Conclusion This abstract describes a rare case of acute generalized exanthematous pustulosis seen in a patient after the use of levofloxacin. Acute generalized exanthematous pustulosis is a rare adverse effect of medications particularly antibiotics and diltiazem. Diagnostic criteria include characteristic presentation with febrile pustular rash (usually within 48 hours of medication use) that improves with drug discontinuation, leucocytosis with marked neutrophilia (neutrophil > 7000/mm3), and pustular smear negative for bacteria. Other findings that may occur include mild eosinophilia, transaminitis, and elevated creatinine. Our patient had the characteristic rash, positive history of antibiotic use, leucocytosis with marked neutrophilia, elevated ALT, and improvement in rash after discontinuation of causative antibiotic. Diagnosis is confirmed by histology of punch biopsy of pustular rash showing intra- or sub corneal spongiform pustules, eosinophils in the pustules or dermis, necrotic keratinocytes, superficial, interstitial, and mid-dermal neutrophil rich infiltrates, and absent dilated blood vessels. Management is by withdrawing and avoiding future use of causative medication, supportive care, and use of topical corticosteroid for rash.
Presentation Type
Poster
Recommended Citation
Akande, Rukayat and Chaglasian, Johanne, "Acute generalized exanthematous pustulosis secondary to levofloxacin use" (2024). Research Colloquium. 22.
https://scholarworks.utrgv.edu/colloquium/2023/posters/22
Included in
Acute generalized exanthematous pustulosis secondary to levofloxacin use
Background We present a patient who developed pustular rash following levofloxacin use. Acute generalized exanthematous pustulosis is a rare drug reaction. This abstract will review the patient’s symptoms, diagnosis and management.
Case presentation 25-year-old man presented with fever, facial swelling, and pruritic rash on face and body of a day duration. Two days prior, he had been prescribed levofloxacin for a sore throat. His symptoms developed within 24 hours of his first use of levofloxacin. He denied previous use of levofloxacin. His vital signs were T 101.7, RR 18, HR 114, BP 112/59, SPO2 100% on RA. On examination, he had pustular rash overlying edematous and erythematous skin on his face and abdomen. He also had facial and lip swelling. Other physical examination findings were within normal limit. Significant lab report showed WBC 21,120/mm3 with neutrophil count 18000/mm3, lactic acid 2.07, and ALT 67. Acute generalized exanthematous pustulosis was diagnosed presumptively. His levofloxacin was discontinued. He was given diphenhydramine and dexamethasone. His facial swelling resolved, his leucocytosis improved, and his rash improved remarkedly and became non-pruritic. He was discharged on topical corticosteroid therapy.
Conclusion This abstract describes a rare case of acute generalized exanthematous pustulosis seen in a patient after the use of levofloxacin. Acute generalized exanthematous pustulosis is a rare adverse effect of medications particularly antibiotics and diltiazem. Diagnostic criteria include characteristic presentation with febrile pustular rash (usually within 48 hours of medication use) that improves with drug discontinuation, leucocytosis with marked neutrophilia (neutrophil > 7000/mm3), and pustular smear negative for bacteria. Other findings that may occur include mild eosinophilia, transaminitis, and elevated creatinine. Our patient had the characteristic rash, positive history of antibiotic use, leucocytosis with marked neutrophilia, elevated ALT, and improvement in rash after discontinuation of causative antibiotic. Diagnosis is confirmed by histology of punch biopsy of pustular rash showing intra- or sub corneal spongiform pustules, eosinophils in the pustules or dermis, necrotic keratinocytes, superficial, interstitial, and mid-dermal neutrophil rich infiltrates, and absent dilated blood vessels. Management is by withdrawing and avoiding future use of causative medication, supportive care, and use of topical corticosteroid for rash.