Acute Generalized Exanthematous Pustulosis Induced by Galantamine Pustulosis exantemática aguda generalizada inducida por galantamina

At present, Alzheimer disease has no effective treatment due to its complex pathophysiology, which is not yet completely understood. However, abnormal cholinergic function has been shown to play an important role in the many types of brain neurotransmitter dysfunction found in Alzheimer patients. Accordingly, cholinesterase inhibitors that strengthen cholinergic neurotransmission, including galantamine, donepezil, and rivastigmine, are considered first-line drugs for the treatment of mild to moderate Alzheimer disease. We present the first reported case of acute generalized exanthematous pustulosis (AGEP) following the administration of galantamine. An 81-year-old woman with a history of hypertension, dyslipidemia, spondyloarthropathy, and recently diagnosed Alzheimer-type degenerative dementia was brought to our department for emergency examination. She presented with a generalized itchy skin rash that had developed 5 days earlier, associated with a sensation of poor temperature regulation and no measurable fever. The physical examination showed large erythematous, edematous plaques on the trunk and limbs with multiple nonfollicular monomorphic pustules. The lesions on the limbs were more isolated and had a target morphology (Fig. 1). Small isolated areas of superficial epidermal detachment were also observed. No involvement of the oral or genital mucosa or ocular discomfort was observed. Palpation did not reveal visceromegaly or enlarged lymph nodes. The only relevant recent change in medication was the addition of galantamine, which had been prescribed by the neurologist in the preceding month to treat the patient’s