Abstract:

Drug eruptions can display an array of clinical and histological patterns. Some presentations may have a classic appearance, but others may display mixed or overlapping features leading to diagnostic confusion. We present two cases of acute, widespread, pustular, and polymorphous eruptions with onset after the initiation of new medications. The first case demonstrated a diffuse polymorphous eruption consisting of pustules, targetoid macules, and dusky macules and patches in a young woman approximately two months after starting bupropion for depression. Similarly, the second case demonstrated diffuse purpuric papules and plaques studded with pustules in a young man approximately two days after starting amoxicillin for a dental infection. Skin biopsy of each case demonstrated features of acute generalized exanthematous pustulosis with subcorneal and spongiform pustules and eosinophils as well as leukocytoclastic vasculitis. In the cases presented, a well-documented exposure to medications preceding the acute onset of cutaneous eruptions was present. Conversely, significant improvement was noted after discontinuation of these medications along with use of systemic and topical steroids. Given that the literature has few such documented cases, we present these cases to bring awareness that leukocytoclastic vasculitis can be observed in a small subset of cases of acute generalized exanthematous pustulosis.

Financial Disclosure:
No current or relevant financial relationships exist.

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Garrett Vick, MD