Antibacterials
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Acute generalised exanthematous pustulosis (first report with sulbactam/ampicillin, amikacin and cefixime) in paediatric patients: 4 case reports Three boys and one girl developed acute generalised exanthematous pustulosis (AGEP) during treatment with antibacterials [dosages and routes not stated]. In all four patients, cessation of all medications and treatment with antihistamines led to rapid resolution of skin lesions within 2 days. A 9-year-old boy, who had rectal atresia with colostomy, started receiving sulbactam/ampicillin, clindamycin and amikacin. He developed a skin eruption and fever on the first day of therapy; he exhibited maculo-papular eruptions on his face, and an erythematous eruption with nonfollicular pustules on his trunk and abdomen. His WBC count was 11.900/µL [sic] with 4% eosinophils. Histopathological findings included epidermal acanthosis, lymphocytic spongiosis, spongiform pustules and perivascular neutrophilic infiltration. A skin patch test was positive for ampicillin, but negative for clindamycin. Four months later, he was hospitalised with a maculopapular rash on his trunk, which had appeared on the first day of therapy with cefixime [indication not stated]; the drug was stopped, and he was advised not use any β-lactam antibacterials in the future. A 6-year-old boy with acute laryngitis started receiving cefixime and methylprednisolone, and developed fever and an erythematous skin eruption with nonfollicular pustules on his face and extremities on treatment day 6. He had a WBC count of 14.300/µL [sic] with 8% eosinophils. Histopathology revealed epidermal pustules, keratinocyte necrosis and perivascular neutrophilic infiltration. Patch tests were negative for steroids and cefixime. An 11-year-old girl started receiving sulbactam/ ampicillin, clindamycin and amikacin for acute appendicitis. On day 3, she developed fever, and an erythematous skin eruption covered with nonfollicular pustules and maculopapular eruptions on her trunk and proximal extremities. Her WBC count was 23.000/µL [sic] with 8% eosinophils. A 16-year-old boy, whose history included intestinal obstruction with coleostomy, started receiving ampicillin, clindamycin and amikacin. On the third day of therapy, he developed an erythematous eruption with numerous nonfollicular pustules on his trunk and extremities; he also had fever. His WBC and eosinophil counts were 10.200/µL [sic] and 6.5%, respectively. Author comment: "The drugs were probable causes in our four patients. . . The symptoms began on the first day in Case 1, on the third day in Cases 3 and 4. In the second case that used steroid and cefixime, the lesions appeared on the sixth day. The reason of the lesions seen in a later time was thought to be the patient’s steroid usage." Ozmen S, et al. Is acute generalized exanthematous pustulosis an uncommon condition in childhood?. Allergy 65: 1490-1492, Nov 2010. Available from: URL: 803047229 http://dx.doi.org/10.1111/j.1398-9995.2010.02377.x - Turkey
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