Acute generalized exanthematous pustulosis mimicking toxic epidermal necrolysis in patients with psoriasis: a coincidence?

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Conflict of interest: the authors declare that they have no conflicts of interest. In 2012, we reported in Clinical and Experimental Dermatology a case of severe acute generalized exanthematous pustulosis (AGEP) with blistering, mimicking toxic epidermal necrolysis (TEN), resulting from flucloxacillin treatment in a young woman with a history of psoriasis treated with ciclosporin (3 mg/kg).1 We now report a strikingly similar second case of this rare clinical entity, this time managed successfully with pulsed intravenous methylprednisolone at a dose of 1 g/kg/day for 3 days, followed by a reducing course of oral prednisolone. A 23‐year‐old white woman presented to us 2 weeks following a course of flucloxacillin for otitis media. She had a history of mild psoriasis. On physical examination, the patient was found to be pyrexial, with a temperature of 38.8 °C. She had generalized erythema, painful blisters positive for Nikolsky sign, and sloughing covering 80% of her body (Fig. 1a). On both shins, she had sheets of multiple nonfollicular sterile pustules (Fig. 1b) on an erythematous background, with targetoid lesions on her palms (Fig. 1c). She had marked facial and generalized oedema (Fig. 1d), with no mucosal membrane involvement. A diagnosis of TEN was suspected. Intravenous (IV) immunoglobulin was commenced at a dose of 1 mg/kg/day for 3 days, and the patient was transferred to the intensive care unit for supportive care.

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