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Carbimazole induced agep

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Dr santosh km
Dr santosh km

A 50-year-old man developed a widespread pustular rash 48 hours after starting carbimazole treatment for hyperthyroidism. Tests revealed neutrophilic leucocytosis. The rash subsided within 5 days of stopping the carbimazole. Carbimazole has been linked to various skin conditions but acute generalized exanthematous pustulosis (AGEP) is rare. Only one previous case of carbimazole-induced AGEP has been reported. AGEP should be considered when a patient rapidly develops numerous sterile pustules after starting a new drug.

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POSTER PRESENTATION Open Access Carbimazole induced acute generalised exanthematous pustulosis Madhavi Kadambi1* , santhosh K M2 , murali mohan BV2 , tousheed syed3 From EAACI Skin Allergy Meeting 2014 Krakow, Poland. 18-20 September 2014 Background Acute generalised exanthematous pustulosis (AGEP) also known as pustular drug eruption is an unusual drug induced hypersensitivity skin manifestation, characterized by acute onset of fever, and numerous non-follicular pin- head sterile pustules on erythematous background , usually over the flexural areas and face [1]. Neutrophils are involved in the pathogenesis of AGEP. Neutrophil- activating cytokines like IL-3 and IL-8 have been impli- cated [2]. Around 90 percent of the times AGEP is caused by a drug. Reported most often due to antibacterials. Car- bimazole which is a thiourea antithyroid drug is not one of the usual suspect. Method We report a case of a 50-year-old man with history of chronic diarrhea since 2 years, subsequently diagnosed as hyperthyroidism, without a previous history of psoriasis, developed a widespread, pin head pustular eruption on the face and extremities 48 hours after starting carbimazole for hyperthyroidism.His blood investigations revealed neu- trophilic leucocytosis. The offending drug was stopped on day 3 and the pustules subsided by day 5. He was started on propylthiouracil instead of carbimazole, which he toler- ated well. Patient refused skin biopsy and patch testing. Conclusion Carbimazole in the past has been associated with ANCA associated vasculitis and vasculitic rash, urticaria, alopecia and maculopapular rashes. Carbimazole causing AGEP is not a common occurance. Only one case has been reported till now by Grange-Prunier et al in an 83 year old lady [2]. AGEP can often be confused with pustular psoria- sis and clinical distinction between the two is difficult. His- tologically the presence of spongiosis, eosinophilic exocytosis, apoptotic keratinocytes and minimal acanthosis may favor the diagnosis of AGEP [3], whilst the presence of acanthosis and papillomatosis may support pustular psoriasis.The most important finding is the disappearance of the rashes with discontinuation of the drug. AGEP is a self limmiting disease with generalised sterile pustulosis. The clue to the diagnosis is the rapidity with which it developes after starting a drug. The short time for onset of lesions is thought to be due to previous sensitiza- tion. The course is usually uneventful and the patient usually recovers within few days of stopping the drug. Consent Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Authors¡¯ details 1 Narayana Health Mazumdar Shaw Multispecialty Hospital, bangalore; India. 2 Narayana Health Mazumdar Shaw Multispecialty Hospital, internal medicine, bangalore; India. 3 Narayana Health Mazumdar Shaw Multispecialty Hospital, respiratory medicine, Bangalore, India. Published: 11 March 2015 References 1. Pecina JL, Cappel MA: Acute generalized exanthematous pustulosis. Skinmed 2010, 8(4):210-214. 2. Grange-Prunier A, Roth B, Kleinclaus I, Fagot JP, Guillaume JC: Acute generalized exanthematous pustulosis induced by carbimazole (Neomercazole): first reported case and value of patch tests. Ann Dermatol Venereol 2006, 133(8-9 Pt 1):708-10. 3. Speeckaert MM, Speeckaert R, Lambert J, Brochez L: Acute generalized exanthematous pustulosis: an overview of the clinical, immunological and diagnostic concepts. Eur. J. Dermatol 2010, 20(4):425-433. doi:10.1186/2045-7022-5-S1-P16 Cite this article as: Kadambi et al.: Carbimazole induced acute generalised exanthematous pustulosis. Clinical and Translational Allergy 2015 5(Suppl 1):P16. 1 Narayana Health Mazumdar Shaw Multispecialty Hospital, bangalore; India Full list of author information is available at the end of the article Kadambi et al. Clinical and Translational Allergy 2015, 5(Suppl 1):P16 http://www.ctajournal.com/content/5/S1/P16 ? 2015 Kadambi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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Carbimazole induced agep

  • 1. POSTER PRESENTATION Open Access Carbimazole induced acute generalised exanthematous pustulosis Madhavi Kadambi1* , santhosh K M2 , murali mohan BV2 , tousheed syed3 From EAACI Skin Allergy Meeting 2014 Krakow, Poland. 18-20 September 2014 Background Acute generalised exanthematous pustulosis (AGEP) also known as pustular drug eruption is an unusual drug induced hypersensitivity skin manifestation, characterized by acute onset of fever, and numerous non-follicular pin- head sterile pustules on erythematous background , usually over the flexural areas and face [1]. Neutrophils are involved in the pathogenesis of AGEP. Neutrophil- activating cytokines like IL-3 and IL-8 have been impli- cated [2]. Around 90 percent of the times AGEP is caused by a drug. Reported most often due to antibacterials. Car- bimazole which is a thiourea antithyroid drug is not one of the usual suspect. Method We report a case of a 50-year-old man with history of chronic diarrhea since 2 years, subsequently diagnosed as hyperthyroidism, without a previous history of psoriasis, developed a widespread, pin head pustular eruption on the face and extremities 48 hours after starting carbimazole for hyperthyroidism.His blood investigations revealed neu- trophilic leucocytosis. The offending drug was stopped on day 3 and the pustules subsided by day 5. He was started on propylthiouracil instead of carbimazole, which he toler- ated well. Patient refused skin biopsy and patch testing. Conclusion Carbimazole in the past has been associated with ANCA associated vasculitis and vasculitic rash, urticaria, alopecia and maculopapular rashes. Carbimazole causing AGEP is not a common occurance. Only one case has been reported till now by Grange-Prunier et al in an 83 year old lady [2]. AGEP can often be confused with pustular psoria- sis and clinical distinction between the two is difficult. His- tologically the presence of spongiosis, eosinophilic exocytosis, apoptotic keratinocytes and minimal acanthosis may favor the diagnosis of AGEP [3], whilst the presence of acanthosis and papillomatosis may support pustular psoriasis.The most important finding is the disappearance of the rashes with discontinuation of the drug. AGEP is a self limmiting disease with generalised sterile pustulosis. The clue to the diagnosis is the rapidity with which it developes after starting a drug. The short time for onset of lesions is thought to be due to previous sensitiza- tion. The course is usually uneventful and the patient usually recovers within few days of stopping the drug. Consent Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal. Authors¡¯ details 1 Narayana Health Mazumdar Shaw Multispecialty Hospital, bangalore; India. 2 Narayana Health Mazumdar Shaw Multispecialty Hospital, internal medicine, bangalore; India. 3 Narayana Health Mazumdar Shaw Multispecialty Hospital, respiratory medicine, Bangalore, India. Published: 11 March 2015 References 1. Pecina JL, Cappel MA: Acute generalized exanthematous pustulosis. Skinmed 2010, 8(4):210-214. 2. Grange-Prunier A, Roth B, Kleinclaus I, Fagot JP, Guillaume JC: Acute generalized exanthematous pustulosis induced by carbimazole (Neomercazole): first reported case and value of patch tests. Ann Dermatol Venereol 2006, 133(8-9 Pt 1):708-10. 3. Speeckaert MM, Speeckaert R, Lambert J, Brochez L: Acute generalized exanthematous pustulosis: an overview of the clinical, immunological and diagnostic concepts. Eur. J. Dermatol 2010, 20(4):425-433. doi:10.1186/2045-7022-5-S1-P16 Cite this article as: Kadambi et al.: Carbimazole induced acute generalised exanthematous pustulosis. Clinical and Translational Allergy 2015 5(Suppl 1):P16. 1 Narayana Health Mazumdar Shaw Multispecialty Hospital, bangalore; India Full list of author information is available at the end of the article Kadambi et al. Clinical and Translational Allergy 2015, 5(Suppl 1):P16 http://www.ctajournal.com/content/5/S1/P16 ? 2015 Kadambi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.