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Paracetamol/promethazine/dextromethorphan Acute generalised exanthematous pustulosis: case report

A 29-year-old man developed acute generalised exanthematous pustulosis (AGEP) following treatment with paracetamol/ promethazine/dextromethorphan. The man was admitted due to cough, malaise and fever along with a pustular eruption for 2 days. The rash developed within 24 hours of ingesting over-the-counter cough preparations- capsules containing paracetamol/promethazine [promethazine hydrochloride]/dextromethorphan [Night nurse; dosage not stated] along with paracetamol/dextromethorphan/pseudoephedrine [pseudoephedrine hydrochloride; Day nurse]. He was not on any concomitant medications, and his medical history was unremarkable. He had experienced a similar but mild rash 9 years prior after taking an unspecified cough medication. Dermatological examination showed a predominantly flexural eruption and hundreds of tiny, non-follicular pustules on a background of macular erythema, which affected the abdominal apron fold, groins, thighs and buttocks. He also had macular erythema affecting his upper arms, popliteal fossae and axillae. Mucosal membrane involvement was not observed. Skin biopsy demonstrated sub-corneal pustules, a superficial dermal neutrophilic infiltrate and occasional sub-epidermal bullae filled with neutrophils. He was diagnosed with AGEP. The man was treated with unspecified topical corticosteroids and emollients. Complete resolution of rash was observed within 10 days. Patch tests were performed, which were found to be positive for paracetamol/promethazine/dextromethorphan compound. However, dextromethorphan was not available for testing, but was suspected as the cause of the reaction. Rashid RS, et al. Acute generalized exanthematous pustulosis due to dextromethorphan. Contact Dermatitis 83: 424-425, No. 5, Nov 2020. Available from: URL: http:// doi.org/10.1111/cod.13633 803518966

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Editorial comment: Details of this case report have previously been published and processed for Adis PV [see Reactions 1635 p113; 803217921].

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Reactions 5 Dec 2020 No. 1833