PMC4737844_01
Diffuse erythematous eruption with nonfollicular pinhead-sized pustules on both extremities and the trunk appearing after 9 days of treatment with piperacillin/tazobactam (A~C), subsequent improved status of the skin with desquamations on the neck, arm, and abdomen (D~F), and erythematous patches with previous desquamations on the 20th day after initiation of the antibiotic therapy (G~I).
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F1
The rash consisted of diffuse pruritic erythematous eruptions with nonfollicular pinhead-sized pustules on the neck, trunk, and both upper and lower extremities, sparing the mucous membranes (Fig. 1A~C). The pustules and neutrophilia rapidly resolved (Fig. 1D~F). However, on the 20th day of antibiotic therapy, she developed a generalized erythematous rash, again with desquamations that occurred after pustules (Fig. 1G~I).
Histopathology showing a subcorneal pustule with epidermal spongiosis and perivascular inflammation of lymphocytes and eosinophils in the upper dermis (H&E; A: x40, B: x100, C and D: x200).
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F2
Histopathology revealed subcorneal pustules with epidermal spongiosis and perivascular inflammation of lymphocytes and eosinophils in the upper dermis (Fig. 2).
Eosinophil and neutrophil percentages with references according to day. Day 0 indicates the day before treatment with piperacillin/tazobactam, and day 1 indicates the first day of treatment. AGEP: acute generalized exanthematous pustulosis, DRESS: drug-related rash with eosinophilia and systemic symptoms.
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F3
Blood tests revealed eosinophilia (36%, Fig. 3), atypical lymphocytes, and an increase in liver enzyme levels (aspartate aminotransferase, 90 IU/L; alanine aminotransferase, 64 IU/L; alkaline phosphatase, 568 IU/L).