Pustulosis Eksantema Generalisata Akut

Abstract

Abstract: Acute generalised exanthematous pustulosis (AGEP) is a variant of severe drug allergic eruption that usually occurs very acutely (one day after antibiotic consumption, with a mean of 11 days in other cases), associated with fever. Early lesions are edematous and erythemaous patches followed by nonfollicular pustules. Laboratory examination showed leukocytosis dominated by neutrophils, occasionally by eosinophils. We reported a female of 64 years old with AGEP in the arms, neck, chest, back, and thighs that occurred one day after consumption of a decongestant drug, that became worsened with the eruption of pustules associated with fever one day after consumption of tetracycline, paracetamol, and diphenhydramine. Dermatological status showed nonfollicular pustules on erythematous skin, either discrete or confluenced. Gram examination of the pustules revealed PMN leucocytes. Routine blood examination showed leukocytosis 20,200/mm3. Blood smear showed eosinophil 0%, basophil 0.1%, neutrophil 90.4%, lymphocyte 7.3%, and monocyte 2.2%. Moreover, IgE total was 2,930 IU/ml. The patient was treated with methylprednisolon 62.5 mg intravenous and then the dose was tappered gradually. The patient improved at days 10 followed by desquamation. Conclusion: In this case, diagnosis of AGEP was based on anamnesis, physical examination, and other supporting tests. Steroid therapy resulted in satisfying improvement.
Keywords: AGEP, allergic drug eruption

Abstrak: Pustulosis eksantema generalisata akut (PEGA) adalah varian erupsi alergi obat tipe berat. Erupsi PEGA biasanya terjadi tiba-tiba (satu hari setelah mengonsumsi antibiotik, rerata 11 hari pada kasus lainnya), dan disertai demam. Lesi awal berupa bercak merah yang diikuti munculnya pustul nonfolikular pada kulit yang eritematosa dan edematosa. Pemeriksaan laboratorium menunjukkan leukositosis dengan dominasi neutrofil, kadang eosinofil. Kami melaporkan kasus PEGA pada seorang perempuan, 64 tahun di daerah lengan, leher, dada, punggung, dan paha yang timbul sejak satu hari setelah mengonsumsi obat pilek. Keluhan semakin parah dengan munculnya bintil bernanah disertai demam sehari setelah mengonsumsi tetrasiklin, parasetamol, dan difenhidramin. Status dermatologik didapatkan pustul nonfolikular di atas kulit yang eritematosa, sebagian pustul diskret dan sebagian kecil berkonflues. Pemeriksaan Gram dari cairan pustul mendapatkan leukosit PMN. Pemeriksaan darah rutin memperlihatkan: leukosit 20.200/mm3. Apusan darah tepi didapatkan: eosinofil 0%, basofil 0,1%, neutrofil 90,4%, limfosit 7,3%, monosit 2,2%. Pemeriksaan IgE total 2.930 IU/ml. Pasien diterapi metilprednisolon 62,5 mg intravena, selanjutnya dosis diturunkan secara bertahap. Perbaikan pasien tampak pada hari perawatan ke-10 diikuti terjadinya deskuamasi. Simpulan: Telah dilaporkan kasus PEGA dengan diagnosis ditegakkan berdasar anamnesis, pemeriksaan fisik, dan penunjang. Terapi steroid menunjukkan hasil yang memuaskan
Kata kunci: pustulosis eksantema generalisata akut, erupsi alergi obat