Microsoft Word - DRM070BF

PEAG Adverse drug reaction Hydroxychloroquine P. Saiag, Service de Dermatologie, CHU Ambroise Paré, 9, avenue du Général de Gaulle, F-92104 Boulogne Cedex (France) Antimalarial drugs may induce numerous cutaneous adverse drug reactions (ADR): pruritus, lichenoid and urticarial skin eruptions, mucocutaneous hyperpigmentation, as well as exacerbation of psori-sis. We report here a case of hydroxychloroquine-induced acute generalized exanthematous pustulosis (AGEP), a infrequently reported ADR with this drug. A 36-year-old woman with seronegative polyarthritis presented with an acute febrile eruption of 6 days’ duration. Hydroxychloroquine (HCQ), 200 mg/day was started 12 days before the onset of the eruption because her arthralgias did not respond to prednisone (10 mg/day). She has received no other treatment for the last 2 months and denied any previous ADR. There was neither personal nor familial history of psoriasis. The eruption consisted of generalized, nonfollicular pustules on erythematous base with some target-like lesions (fig. 1). Significant edema and purpuric lesions of the legs were also noticed. Besides conjunctival erythema and cheilitis, there was no other mucosal involvement. Physical examination was normal except for fever (38.5 °C) and intense general malaise. The erythrocyte sedimentation rate was 30 mn in the first hour and the leukocytosis 26,700/mm3 with a polymorphonuclear count of 24,100/mm3. Chest radiographs, liver function tests, serum mercury concentration and blood creatinine were normal. Cultures from pustule contents were negative for bacterial and fungal organisms. Skin biopsy revealed spongiform subcorneal pustules and a diffuse dermal lymphocytic infiltrate. Repeated serologic tests for cytomegalovirus, Epstein-Barr virus, Parvovirus B19, echoand coxsackievirus were negative. Desquamation began a few days after hospitalization and a spontaneous complete resolution was obtained 1 week later. Nineteen months later there was no sign of psoriasis. The main clinical and biological criteria of AGEP were described by Roujeau et al. [1J based on the analysis of 63 cases [1]. This entity is characterized by a sudden and simultaneous onset of high fever and widespread edematous scarlatiniform rash, soon covered by hundreds of nonfollicular, small, superficial pustules. The disease is rapidly self-limiting, fever and pustules