Table 3 AGEP and TEN overlap cases—literature review
Source | Patient | Culprit drug | Clinical description | Time onset | Biopsy | Treatment | Outcome |
|---|---|---|---|---|---|---|---|
Cohen et al. [16] | M 91 | Cefuroxime Paracetamol | Generalized erythema (95%), non follicular pustules, bullae (clear) Skin detachment (41%) Nikolsky+ | 10 days after drug initiation | Spongiform pustules, papillary edema, perivascular mononuclear infiltrate | d/c drug Wet dressing | Resolution after 10 days |
Scheinfeld et al. [17] | F 60 | Famotidine | Generalized erythema, pustules Erosions Nikolsky+ | 2 days after drug initiation | Subcorneal blistering, no necrotic keratinocytes | d/c drug Clobetasol propionate | Resolution after 3 days |
Byerly et al. [18] | F 45 | Valdecoxib | Generalized erythema, nonfollicular Pustular papules and plaques; 80% BSA Nikolsky− | 5 days after drug initiation | Spongiform pustules, neutrophilic and eosinophilic infiltrate | d/c drug Wet dressing (bacitracin) IV fluids | n/a |
Meiss et al. [5] | M 34 M 49 M 43 | Ampilicillin, sulfabactam Clindamycin Amoxicillin | Edematous erythema Oinhead-sized pustules, bullae formation + exfoliation Nikolsky+ | n/a | M 49-keratinocytes necrosis of basal layer, neutrophils with subcorneal pustule formation | d/c drug Infliximab | Resolution after 6-14 days |
Goh et al. 2008 [4] | F 28 | Carbamazepine | Generalized erythema Non-follicular pustules + clear bullae; 55% BSA, Mq membrane Nikolsky+ | 14 days after drug initiation | Mild spongiosis, subcorneal pustule, necrosis of the epidermis | d/c drug IV Hydrocortisone IV Ig | Resolution after 9 days Minimal scarring |
Lateef et al. [19] | F 67—SLE | Hydroxy-chloroquine | Generalized erythema Entire BSA, targetoid patches Conjunctivitis Extensive desquamation | 19 days after drug initiation | Epidermal spongiosis, intradermal infiltrate of neutrophils | d/c drug, IV fluids IV Hydrocortisone IV Ig | Resolution after 16 days Minimal scarring |
Sadighha et al. [15] | F 56 | Amoxicillin/clavulanic acid | Pustules, vesicles, blisters, erythema multiforme-like lesions Oral + conjunctival inflammation | 3 days after drug initiation | Keratinocyte necrosis of the basal layer | d/c drug IV fluids Etanercept s/c | Resolution after 18 days |
Peermohamed et al. [20] | M 20 | Piperacillin and tazobactam | Diffuse erythema, nonfollicular pustules vesicles and bullae Nikolsky+ | 1 days after drug initiation | Intraepidermal pustules, bulla formation, no necrosis | d/c drug IV Hydrocortisone IV Ig | Resolution after 14 days No scarring |
Kardaun et al. [21] | F 70 | Morphine | Generalized erythematous eruption Flexure Tiny pustules Superficial erosions | 8 days after drug initiation | Spongiform subcorneal pustules, neutrophilic spongiose, few necrotic keratinocytes | d/c drug | Resolution after 14 days |
Natkunarajah et al. [14] | F 19 | Flucloxacillin | Pin-head pustules on confluent erythema Vesicles, bullae Nikolsky+ | 5 days after drug initiation | Subcorneal pustule | d/c drug Ciclosporin PO | Resolution after 7 days |
Hattem et al. [22] | F 30 | Flucloxacillin | Generalized erythema, pustules Large bullae + erosions Nikolsky+ | 5 days after drug initiation | Spongiform subcorneal pustules + neutrophils, dermal edema | d/c drug IV fluids IV Hydrocortisone | Resolution after 10 days |
Moling et al. [23] | M 29 | Amoxicillin/clavulanic acid | Severe mucositis and pustules Nikolsky+ | 5 days after drug initiation | n/a | d/c drug IV methyl- prednisolone | Hopital discharge after 5 days |
Kiyohara et al. [24] | M 37 | Lamotrigine | Vesicles, pustules, bullae on erythematous base Nikolsky+ | 14 days after drug initiation | Subcorneal pustules, interface dermatitis | d/c drug Prednisolone PO | Resolution after 10 days |
Smith et al. [11] | F 36 | Flucloxacillin | Generalized erythema (90%), pustules, bullae Nikolsky+ | n/a | Multiple subcorneal pustules, epidermal necrosis | d/c drug | n/a Full recovery |
Worsnop et al. [25] | F 23 | Flucloxacillin | Generalized erythema, painful blisters Nikolsky+ | 14 days after drug course | Papillary dermal edema, subepidermal bullae, subcorneal pustule | d/c drug IV Ig IV methyl-prednisolone | n/a Skin healed |
Horcajada-Reales et al. [26] | F 87 | Amlodipine or Furosemide | Erythematous plaques—violaceous center, detachment, perilabial Nikolsky+ | 7 days after drug initiation | Subcorneal plaques, perivascular dermal infiltrate | d/c drug IV Ig IV corticosteroids | Resolution after 14 days |
Horcajada-Reales et al. [26] | F 75 | Teicoplanin Amlodipine | Papulopustular exanthema trunk + limbs Epidermal detachment (30%), labial mucosa Nikolsky+ | 1 days after drug initiation | Pustules, spongiose, dense superficial perivascular inflammatory infiltrate | d/c drug IV corticosteroids | Resolution after 3 days |
García Abellán et al. [27] | F 82 | Trimethoprim Sulfamethoxazole | Violaceous exanthema Skin detachment Nikolsky+ | 14 days after drug initiation | Subcorneal pustules, neutrophils | d/c drug Prednisone PO IV Ig | Resolution after 8 days |
Moreno-Arrones et al. [3] | F 90 | Vismodegib | Generalized erythema Plaques with purpuric centers—head, folds, and trunk Skin detachment 15% Nikolsky + | 8 days after drug initiation | Neutrophilic spongiotic pustules without epidermal necrosis | d/c drug, Ciclosporin | Resolution after 14 days |