II. Causes: ABCDS Mnemonic
- See Anaphylaxis
-
Acute Generalized Exanthematous Pustulosis (AGEP)
- Non-follicular Pustular lesions at the flexor surfaces
- Within 4 days of beta lactam, Macrolide or Calcium Channel Blocker exposure
- Associated fever, Leukocytosis and Neutrophilia
-
Drug-Induced Bullous Disease
- Bullae insidious onset with ACE Inhibitors, beta-lactam Antibiotics, Calcium Channel Blockers, Furosemide, Vancomycin
- Captopril or ACE inhibitor Induced Angioedema
-
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS Syndrome)
- Presentation similar to Fixed Drug Eruption (Morbilliform rash) presentation, but >2 weeks after exposure
- Anticonvulsants (esp. Dilantin) are most common causes, but also occurs with Sulfonamides and Allopurinol
- Associated with fever, Lymphadenopathy, nephritis, Transaminitis, Eosinophilia, Myositis, Encephalitis
- Mortality approaches 10% due to fulminant liver failure
-
Stevens-Johnson Syndrome (10% BSA) or Toxic Epidermal Necrolysis (30% BSA)
- Onset 7-21 days after exposure to Sulfonamides, anticonvulsants, NSAIDs, Allopurinol
- Macules, target lesions and erosions with skin sloughing and mucous membrane involvement
III. References
- Jhun and DeClerck in Herbert (2015) EM:Rap 15(2): 9-11