Acute generalized exanthematous pustulosis: A rare side effect of a common over-the-counter drug, Acetylsalicylic acid
A 48-year-old male patient, with no known comorbidities, presented with complains of mildly itchy rash with fever of two-day duration. The rash started from neck and progressed over two days to involve entire trunk and proximal extremities []. He gave history of taking a tablet of ASA for headache, few hours before development of the rash and fever. He had taken the same drug earlier innumerable times in last 15 years, without any side effects; however, it was a 325 mg tablet this time. There was no history of any other drug intake, previous drug allergy, or insect bite. There was no family or personal history of Psoriasis.\nExamination revealed numerous pinhead-sized pustules extensively distributed over upper arms, neck, trunk, and upper thighs over an erythematous background []. The mucous membranes, scalp, palms, and soles were spared. Nails and hair were normal.\nHis Hb was 14.4 g%; TLC, 10 200/mm3; DLC - N 78, L 18, M 02, E 02; Platelet count, 244 000/mm3; and ESR, 30 mm/hr. Liver function tests and urinalysis were within normal limits. No organisms were seen on Gram's stain or isolated on culture of the pustules. Histopathological examination showed subcorneal pustules, a mixed neutrophil-rich interstitial and mid-dermal infiltrate. Tortuous and dilated blood vessels were absent []. The Naranjo Score was 5, which suggested a probable causal association for ASA in this case. The clinicopathological correlation ruled out Pustular Psoriasis, the most common differential diagnosis, in favor of AGEP. He was managed with tapering doses of oral steroids. He responded well and all lesions resolved within 10 days [].