Acute Generalized Exanthematous Pustulosis Complicated by Acute Tubular Necrosis: Case Report


Authors

  • Miguel Angel Montiel Alfonso Universidad Católica Nuestra Señora de la Asunción https://orcid.org/0000-0002-9541-4614
  • Jorge Catalino Avalos Larroza Servicio de Clínica Médica I. Departamento de Medicina Interna. Hospital Central del Instituto de Previsión Social
  • Mauricio Dos Santos García Servicio de Clínica Médica I. Departamento de Medicina Interna. Hospital Central del Instituto de Previsión Social
  • Santiago Troche Von Glasenapp Servicio de Clínica Médica I. Departamento de Medicina Interna. Hospital Central del Instituto de Previsión Social
  • José García Machado Servicio de Clínica Médica I. Departamento de Medicina Interna. Hospital Central del Instituto de Previsión Social

DOI:

https://doi.org/10.22517/25395203.25840

Keywords:

Meropenem, Vancomycin, Severe cutaneous adverse reactions, Acute generalized, Exanthematous pustulosis

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by the rapid onset of non-follicular sterile pustules on an erythematous base. In most cases, it is associated with drug administration, with antibiotics being the most frequently implicated, although a wide range of medications can trigger this condition. Typically, within 48 hours after exposure to the causal drug, fever and pustular eruption accompanied by leukocytosis occur. We present the case of a 57-year-old man admitted to the hospital with a right foot ulcer, who after several days of treatment with meropenem and vancomycin developed a generalized skin rash with fever, leukocytosis with eosinophilia, and acute kidney injury. A skin biopsy confirmed the diagnosis of AGEP. The patient received treatment with methylprednisolone pulses, hydroxyzine, and topical mupirocin, which led to significant clinical improvement and allowed hospital discharge. This case highlights the importance of early recognition of severe antibiotic-induced cutaneous reactions and their potential association with systemic complications such as acute tubular necrosis, underscoring the need for timely diagnostic and therapeutic interventions to reduce morbidity and mortality.

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Published

2026-05-16

How to Cite

Montiel Alfonso, M. A., Avalos Larroza, J. C., Dos Santos García, M., Troche Von Glasenapp, S. ., & García Machado, J. (2026). Acute Generalized Exanthematous Pustulosis Complicated by Acute Tubular Necrosis: Case Report. Revista Médica De Risaralda, 32(1), 171–180. https://doi.org/10.22517/25395203.25840

Issue

Vol. 32 No. 1 (2026): January–June 2026.

Section

Case report

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