Acute generalized exanthematous pustulosis induced by piroxicam: A case report
This was a case report of a 61-year-old female patient who was admitted to internal medicine department for renal colic. She had no history of psoriasis or any other skin disorder. The patient had a history of longstanding arterial hypertension for 3 years treated with captopril, indapamide, nifedipine and diabetes mellitus for 3 years treated with glibenclamide, glimepiride and dyslipidemia treated with simvastatin. She was given oral piroxicam 20 mg/day by her primary care physician for treatment of renal colic. There were no other medications prior to starting piroxicam. At 4 days after starting oral piroxicam, she developed a generalized itchy eruption consisting of multiple papules that sometimes coalesced to larger and scaly plaques, on a background of widespread erythema with associated multiple 2-3 mm pustules []. The mucus membranes, palms and soles were spared. Nikolsky's sign was negative. The remaining physical examination was normal. Her white blood cell count was 10.8 × 103/mm3, with a 6.42 × 103/mm3 neutrophil count. The remaining laboratory tests performed were within the normal range: creatinine 61.1 μmol/l, erythrocyte rate sedimentation at 30 mm/h, C-reactive protein 19.48 mg/l and her liver function tests were: Aspartate transaminase 38 U/ml, bilirubin 9 μmol/l and alkaline phosphatase 88 U/ml. A skin biopsy specimen revealed well-developed subcorneal pustules associated with epidermal spongiosis. Scattered neutrophils as well as eosinophils were noted within the dermis (According to the EuroSCAR score, the most of criteria have been met by our patient who had a score of 9). Within a week of piroxicam withdrawal, the patient's lesions gradually began clearing. The patient remained on the same therapies for her arterial hypertension, diabetes mellitus and dyslipidemia.