Acute generalized exanthematous pustulosis simulating toxic epidermal necrolysis: a case report and review of the literature

Arch Dermatol. 2011 Jun;147(6):697-701. doi: 10.1001/archdermatol.2011.147.


Background: Both acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN) are adverse cutaneous reactions. Despite the fact that these 2 cutaneous reactions differ in presentation, prognosis, pathologic features, and treatment, overlap can exist between them, creating a diagnostic challenge.

Observations: We describe a patient who presented with clinical features of both AGEP and TEN, and we summarize overlapping cases of AGEP-TEN that have been reported in the literature. It is essential to be able to differentiate between AGEP and TEN, as these conditions are clinically and morphologically distinct entities. They also differ considerably in their prognosis and treatment.

Conclusions: Because overlap exists, AGEP should be considered in the differential diagnosis of widespread blistering and erosive conditions. A greater understanding of how to differentiate AGEP and TEN can lead to quicker diagnosis as well as more effective case management and treatment.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Acute Generalized Exanthematous Pustulosis / chemically induced
  • Acute Generalized Exanthematous Pustulosis / diagnosis*
  • Acute Generalized Exanthematous Pustulosis / drug therapy
  • Acute Generalized Exanthematous Pustulosis / pathology
  • Adult
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use
  • Biopsy
  • Diagnosis, Differential
  • Humans
  • Hydrocortisone / therapeutic use
  • Immunoglobulins, Intravenous / therapeutic use
  • Male
  • Penicillanic Acid / adverse effects
  • Penicillanic Acid / analogs & derivatives
  • Penicillanic Acid / therapeutic use
  • Piperacillin / adverse effects
  • Piperacillin / therapeutic use
  • Piperacillin, Tazobactam Drug Combination
  • Prognosis
  • Stevens-Johnson Syndrome / diagnosis*
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Immunoglobulins, Intravenous
  • Piperacillin, Tazobactam Drug Combination
  • Penicillanic Acid
  • Hydrocortisone
  • Piperacillin