Acute generalized exanthematous pustulosis induced by mifepristone

CASE REPORT A 26-year-old woman of Vietnamese descent presented to the emergency department with a widespread, symmetric, erythematous, and pustular eruption (Fig 1). The outbreak initially affected the waistline, and the axillary, inguinal, and inframammary folds. It then spread to involve the neck, wrists, areolae, and the antecubital and popliteal fossae (Fig 2). The pustules were superficial, flaccid, and nonfollicular. They quickly evolved to become confluent, forming purulent lakes (Fig 1). There was sparing of the lower aspect of the legs, palms, soles, and upper aspect of back. Nikolsky sign and mucous membrane involvement were absent. There were no target lesions or blisters. In addition, she experienced a diffuse burning sensation, facial swelling, subjective fevers, and malaise. The patient had consumed 10 mg of mifepristone as emergency contraception 2 days before the eruption. She had not taken any other medications before her eruption and was not previously ill. The mifepristone was purchased without a prescription at a pharmacy in Vietnam. She reported using the medication once prior in a similar circumstance without incident. On presentation, the patient was tachycardic (heart rate: 150 beats/min) with an elevated temperature (37.78C). Laboratory studies demonstrated notable abnormalities of total lymphocyte count 18,000/mm (3500-10,500/mm), absolute neutrophils 17,800/mm (1700-7000/mm), albumin 2.3 g/dL (3.5-5.0 g/dL), calcium 6.5 mg/dL (8.9-10.1 mg/dL), alkaline phosphatase 31 U/L (37-98 U/L), sodium 131 mmol/L (135-145 mmol/L),