Case Letter
Acute localized exanthematous pustulosis induced by paclitaxel
Ana Carolina Tardin Rodrigues de Medeiros
, Juliana Lopes Corrêa, Ademar Schultz Junior, Karina Demoner de Abreu Sarmenghi
Corresponding author
Dermatology Outpatient Clinic, Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil
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"nombre" => "Ademar" "apellidos" => "Schultz Junior" ] 3 => array:2 [ "nombre" => "Karina Demoner de Abreu" "apellidos" => "Sarmenghi" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatology Outpatient Clinic, Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1808 "Ancho" => 1507 "Tamanyo" => 280290 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Post-inflammatory hyperchromia without the presence of pustular lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Acute localized exanthematous pustulosis (ALEP) is an atypical variant of acute generalized exanthematous pustulosis (AGEP), a rare drug reaction.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is an acute, localized subcorneal aseptic pustular eruption, usually affecting the face, cervical region, or thorax.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> The pathophysiological mechanisms remain unclear, although 90% of ALEP cases are drug-induced.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This case report describes a paclitaxel-induced ALEP case in a patient undergoing breast cancer treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 63-year-old woman complained of the appearance of pustules on an erythematous base, symmetrically distributed on the face (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) one week after paclitaxel infusion used as neoadjuvant treatment for breast cancer. She reported pruritus and a local burning sensation and denied having a fever. No mucous membrane lesions were observed. The laboratory tests showed normal values ​​for leukocytes (8,500 mm<span class="elsevierStyleSup">3</span>) and serum C-reactive protein. The pustule secretion culture was negative. The skin biopsy revealed intraepidermal subcorneal pustules and a superficial perivascular lymphocytic infiltrate (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Based on the clinical presentation and histopathological findings, the diagnosis of ALEP was made. The patient was treated with 40 mg of prednisone per day, and chemotherapy was discontinued, with complete remission of the lesions after 14 days (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The follow-up continued by slowly decreasing the dose of corticosteroids.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Acute localized exanthematous pustulosis (ALEP) is a particular form of AGEP. Approximately 25 reports have been published in the literature, confirming that it is a rare drug reaction.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Initially, the condition presents with sterile pustules located on the face, cervical region, or thorax after exposure to the drug, with spontaneous remission after discontinuation of the causative drug.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> Fever and leukocytosis may be present, accompanied by pruritus or a burning sensation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> About 90% of cases are drug-induced, with antibiotics, especially beta-lactams and macrolides, being the most common causative drugs.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Associations with docetaxel, a chemotherapeutic drug of the taxane class, have also been reported in two patients with breast cancer.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As ALEP is a self-limited disease, the mainstay of treatment is the withdrawal of the suspected drug, promoting symptom improvement within a few days. Support therapy with topical or oral corticosteroids may be appropriate for the treatment of pruritus and inflammation in prolonged cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, ALEP is an unusual drug-induced skin reaction, and the majority of published cases were secondary to the use of antibiotics. However, it is important to emphasize that chemotherapeutic agents of the taxane class may also be responsible for this skin reaction.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Ana Carolina Tardin Rodrigues de Medeiros: Statistical analysis; design and planning of the study; drafting and editing of the manuscript; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Juliana Lopes Correa: Collection, analysis, and interpretation of data; drafting and editing of the manuscript; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ademar Schultz Junior: Collection, analysis, and interpretation of data; design and planning of the study; drafting and editing of the manuscript.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Karina Demoner de Abreu Sarmenghi: Approval of the final version of the manuscript; effective participation in research orientation; intellectual participation in the propaedeutic and therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-04-12" "fechaAceptado" => "2021-05-01" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Study conducted at the Hospital Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1775 "Ancho" => 1507 "Tamanyo" => 246698 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presence of pustules on an erythematous base, symmetrically distributed on the face.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1257 "Ancho" => 1674 "Tamanyo" => 484865 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathological examination stained with Hematoxylin & eosin, showing an intraepidermal subcorneal pustule, with superficial perivascular lymphocytic infiltrate, (Hematoxylin & eosin, ×10).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1808 "Ancho" => 1507 "Tamanyo" => 280290 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Post-inflammatory hyperchromia without the presence of pustular lesions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute localized exanthematous pustulosis due to bemiparin" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 25 | 7 | 32 |
| 2024 October | 100 | 79 | 179 |
| 2024 September | 147 | 80 | 227 |
| 2024 August | 152 | 115 | 267 |
| 2024 July | 140 | 114 | 254 |
| 2024 June | 126 | 80 | 206 |
| 2024 May | 93 | 66 | 159 |
| 2024 April | 142 | 87 | 229 |
| 2024 March | 113 | 67 | 180 |
| 2024 February | 94 | 90 | 184 |
| 2024 January | 67 | 47 | 114 |
| 2023 December | 73 | 58 | 131 |
| 2023 November | 92 | 87 | 179 |
| 2023 October | 67 | 68 | 135 |
| 2023 September | 67 | 72 | 139 |
| 2023 August | 65 | 28 | 93 |
| 2023 July | 65 | 26 | 91 |
| 2023 June | 106 | 47 | 153 |
| 2023 May | 49 | 24 | 73 |
| 2023 April | 51 | 22 | 73 |
| 2023 March | 68 | 51 | 119 |
| 2023 February | 49 | 40 | 89 |
| 2023 January | 64 | 32 | 96 |
| 2022 December | 122 | 31 | 153 |
| 2022 November | 101 | 51 | 152 |
| 2022 October | 113 | 54 | 167 |
| 2022 September | 127 | 71 | 198 |
| 2022 August | 85 | 49 | 134 |
| 2022 July | 74 | 54 | 128 |
| 2022 June | 93 | 71 | 164 |
| 2022 May | 99 | 76 | 175 |
| 2022 April | 49 | 48 | 97 |
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