Abstract
A 31-year-old female with a history of asthma who presented to the hospital for evaluation of a new-onset painful rash after revision of a tattoo. She also reports she was prescribed amoxicillin and took one dose of the medication. On clinical examination, she presented with erythematous papules and pustules coalescing into plaques on her face and right upper extremity. The patient’s results for herpes simplex virus, varicella zoster virus, and bacterial culture returned negative. Therefore, a biopsy of a lesion was done, and histopathology revealed epidermal microabscess formation with many dermal eosinophils consistent with acute localized exanthematous pustulosis (ALEP). The patient was started on oral steroids. The likely causative agent was amoxicillin, and she was prescribed oral steroids.
A local presentation of AGEP is also known as acute localized exanthematous pustulosis (ALEP). The most common precipitating factors for AGEP include adverse drug reactions, enteroviral infection, and hypersensitivity reaction secondary to mercury exposure. The most commonly implicated triggers include beta lactam antibiotics and macrolides. Histopathology is a key component of diagnosis and demonstrates characteristic findings of spongiform, subcorneal and intraepidermal pustules, papillary dermis edema, and perivascular neutrophilia and scattered eosinophils. Keratinocyte specific necrosis and leukocytoclastic vasculitis are additional potential findings.
AGEP presenting in a focal geographic distribution is a key indicator that the differential of ALEP should be considered. If there is suspicion for ALEP, histopathological analysis can be invaluable in diagnosis.