{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:00:13Z","timestamp":1780077613155,"version":"3.54.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T00:00:00Z","timestamp":1728691200000},"content-version":"vor","delay-in-days":1062,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"This article received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute generalized exanthematous pustulosis (AGEP) is a severe pustular drug eruption with rare reports of haemodynamic instability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To describe the clinical characteristics, management, and outcomes of patients with AGEP-associated haemodynamic instability.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective case series identified adult patients diagnosed with AGEP who had haemodynamic instability from November 2012 to February 2020 that were seen at two academic teaching hospitals with roles as a burn centre and tertiary referral centre at the University of Texas Southwestern Medical Center in Dallas, TX USA. Patients with a discharge diagnosis of AGEP that had haemodynamic instability during their eruption were included. Patients with a history of psoriasis, presentations thought to be a flare of generalized pustular psoriasis, or concurrent infection during eruption were excluded. AGEP with haemodynamic instability was characterized by degree of hypotension, dermatologic phenotype at time of dermatologic consultation, and management approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>This study included 19 patients with AGEP-associated haemodynamic instability (mean age, 52 years; age range, 29\u201376 years; 11 (58%) female). Patients were classified on a spectrum of haemodynamic instability; three had sustained hypotension, 10 had hypotension with organ dysfunction, and six had shock. Patients with AGEP-associated haemodynamic instability had a range of dermatologic phenotypes at initial consultation: subtle exanthematous eruption with minimal pustules, typical eruption with pustules and flexural predominance, and severe eruption with features of Stevens\u2013Johnson syndrome. Both topical and systemic corticosteroids were used for treatment of several patients. Of the patients that required vasopressors and received systemic steroids, the majority were off vasopressors within 24 h of steroid initiation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Approximately 22% of patients presenting with AGEP to a tertiary referral center had haemodynamic instability. Clinicians should be aware that dermatologic phenotype of AGEP at presentation does not correlate with development of haemodynamic instability.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/ski2.74","type":"journal-article","created":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T04:47:31Z","timestamp":1637038051000},"source":"Crossref","is-referenced-by-count":9,"title":["Clinical Characteristics and Management of Acute Generalized Exanthematous Pustulosis with Haemodynamic Instability"],"prefix":"10.1093","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1390-882X","authenticated-orcid":false,"given":"M.","family":"O\u2019Brian","sequence":"first","affiliation":[{"name":"University of Texas Southwestern Medical Center, University of Texas Southwestern Medical School , Dallas, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. L.","family":"Carr","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center, University of Texas Southwestern Medical School , Dallas, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6464-322X","authenticated-orcid":false,"given":"C.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]},{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8488-3194","authenticated-orcid":false,"given":"A. R.","family":"Dominguez","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]},{"name":"Department of Internal Medicine, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9676-0965","authenticated-orcid":false,"given":"M.","family":"Mauskar","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]},{"name":"Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center , Dallas, Texas ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,15]]},"reference":[{"issue":"5","key":"2025010818032674100_ski274-bib-0001","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/j.1365-2133.2007.08156.x","article-title":"Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR)","volume":"157","author":"Sidoroff","year":"2007","journal-title":"Br J Dermatol"},{"issue":"4","key":"2025010818032674100_ski274-bib-0002","doi-asserted-by":"crossref","first-page":"363","DOI":"10.2340\/00015555-0438","article-title":"Clinical manifestations and characteristics of patients with acute generalized exanthematous pustulosis in Asia","volume":"88","author":"Chang","year":"2008","journal-title":"Acta Derm Venereol"},{"issue":"8","key":"2025010818032674100_ski274-bib-0003","doi-asserted-by":"crossref","DOI":"10.3390\/ijms17081214","article-title":"Acute generalized exanthematous pustulosis: pathogenesis, genetic background, clinical variants and therapy","volume":"17","author":"Feldmeyer","year":"2016","journal-title":"Int J Mol Sci"},{"issue":"3","key":"2025010818032674100_ski274-bib-0004","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1034\/j.1600-0560.2001.028003113.x","article-title":"Acute generalized exanthematous pustulosis (AGEP)\u2014a clinical reaction pattern","volume":"28","author":"Sidoroff","year":"2001","journal-title":"J Cutan Pathol"},{"issue":"6","key":"2025010818032674100_ski274-bib-0005","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1111\/bjd.12502","article-title":"Systemic involvement of acute generalized exanthematous pustulosis: a retrospective study on 58 patients","volume":"169","author":"Hotz","year":"2013","journal-title":"Br J Dermatol"},{"issue":"9","key":"2025010818032674100_ski274-bib-0006","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1001\/archderm.1991.01680080069004","article-title":"Acute generalized exanthematous pustulosis. Analysis of 63 cases","volume":"127","author":"Roujeau","year":"1991","journal-title":"Arch Dermatol"},{"issue":"4","key":"2025010818032674100_ski274-bib-0007","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/ijd.13434","article-title":"Acute generalized exanthematous pustulosis: clinical characteristics, etiologic associations, treatments, and outcomes in a series of 28 patients at Mayo Clinic, 1996\u20132013","volume":"56","author":"Alniemi","year":"2017","journal-title":"Int J Dermatol"},{"issue":"4","key":"2025010818032674100_ski274-bib-0008","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s11882-018-0778-6","article-title":"Severe cutaneous adverse drug reactions: presentation, risk factors, and management","volume":"18","author":"Mustafa","year":"2018","journal-title":"Curr Allergy Asthma Rep"},{"issue":"2","key":"2025010818032674100_ski274-bib-0009","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1159\/000480700","article-title":"Life-threatening atypical case of acute generalized exanthematous pustulosis","volume":"174","author":"Tajmir-Riahi","year":"2017","journal-title":"Int Arch Allergy Immunol"},{"issue":"3","key":"2025010818032674100_ski274-bib-0010","doi-asserted-by":"crossref","first-page":"270","DOI":"10.4037\/ajcc2013987","article-title":"Acute generalized exanthematous pustulosis with multiple organ dysfunction syndrome","volume":"22","author":"Mohyuddin","year":"2013","journal-title":"Am J Crit Care"},{"issue":"4","key":"2025010818032674100_ski274-bib-0011","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1177\/1203475417701421","article-title":"A case of amoxicillin-induced acute generalized exanthematous pustulosis presenting as septic shock","volume":"21","author":"McDonald","year":"2017","journal-title":"J Cutan Med Surg"},{"issue":"1","key":"2025010818032674100_ski274-bib-0012","doi-asserted-by":"crossref","DOI":"10.1186\/s40560-015-0114-3","article-title":"Vancomycin-induced acute generalized exanthematous pustulosis (AGEP) masquerading septic shock\u2014an unusual presentation of a rare disease","volume":"3","author":"Mawri","year":"2015","journal-title":"J Intensive Care"},{"issue":"6-7","key":"2025010818032674100_ski274-bib-0013","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1503\/cmaj.090137","article-title":"Acute generalized exanthematous pustulosis with severe organ dysfunction","volume":"181","author":"Leclair","year":"2009","journal-title":"CMAJ"},{"issue":"3","key":"2025010818032674100_ski274-bib-0014","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1016\/j.jaad.2014.03.007","article-title":"A rapidly progressive and fatal case of atypical acute generalized exanthematous pustulosis","volume":"71","author":"Krishna","year":"2014","journal-title":"J Am Acad Dermatol"},{"issue":"1","key":"2025010818032674100_ski274-bib-0015","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1007\/s10156-011-0297-z","article-title":"Acute generalized exanthematous pustulosis after ceftriaxone use resembling sepsis","volume":"18","author":"Kaya","year":"2012","journal-title":"J Infect Chemother"},{"key":"2025010818032674100_ski274-bib-0016","article-title":"An illusion of septic shock: acute generalised exanthematous pustulosis with multiorgan dysfunction","volume":"2017","author":"Jakkidi","year":"2017","journal-title":"BMJ Case Rep"},{"issue":"10","key":"2025010818032674100_ski274-bib-0017","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2020-235846","article-title":"Acute generalised exanthematous pustulosis associated with shock","volume":"13","author":"Costa","year":"2020","journal-title":"BMJ Case Rep"},{"issue":"8","key":"2025010818032674100_ski274-bib-0018","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.amjmed.2004.01.007","article-title":"Acute generalised exanthematous pustulosis mimicking septic shock","volume":"116","author":"Lesterhuis","year":"2004","journal-title":"Am J Med"},{"issue":"23","key":"2025010818032674100_ski274-bib-0019","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.2146\/ajhp150171","article-title":"Probable fenofibrate-induced acute generalized exanthematous pustulosis","volume":"72","author":"Power","year":"2015","journal-title":"Am J Health Syst Pharm"},{"issue":"4","key":"2025010818032674100_ski274-bib-0020","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1159\/000246286","article-title":"Acute generalized exanthematous pustulosis induced by paracetamol","volume":"193","author":"de Coninck","year":"1996","journal-title":"Dermatology"},{"issue":"3","key":"2025010818032674100_ski274-bib-0021","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.burns.2004.10.017","article-title":"Valdecoxib-associated acute generalized exanthematous pustulosis","volume":"31","author":"Byerly","year":"2005","journal-title":"Burns"},{"issue":"6","key":"2025010818032674100_ski274-bib-0022","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1111\/bjd.13152","article-title":"Severe flucloxacillin-induced acute generalized exanthematous pustulosis (AGEP), with toxic epidermal necrolysis (TEN)-like features: does overlap between AGEP and TEN exist? Clinical report and review of the literature","volume":"171","author":"van Hattem","year":"2014","journal-title":"Br J Dermatol"},{"issue":"1","key":"2025010818032674100_ski274-bib-0023","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1159\/000511369","article-title":"Acute generalized exanthematous pustulosis with multiple organ failure","volume":"13","author":"Syed","year":"2021","journal-title":"Case Rep Dermatol"},{"key":"2025010818032674100_ski274-bib-0024","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/978-3-319-48470-9_11","volume-title":"Sepsis: Definitions, Pathophysiology and the Challenge of Bedside Management","author":"Heffernan","year":"2017"},{"issue":"11","key":"2025010818032674100_ski274-bib-0025","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1172\/JCI12118","article-title":"T-cell involvement in drug-induced acute generalized exanthematous pustulosis","volume":"107","author":"Britschgi","year":"2001","journal-title":"J Clin Invest"},{"issue":"4","key":"2025010818032674100_ski274-bib-0026","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1111\/j.1468-3083.2010.03771.x","article-title":"Increased circulating Th17 frequencies and serum IL-22 levels in patients with acute generalized exanthematous pustulosis","volume":"25","author":"Kabashima","year":"2011","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"5","key":"2025010818032674100_ski274-bib-0027","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1038\/ni.2025","article-title":"Border patrol: regulation of immunity, inflammation and tissue homeostasis at barrier surfaces by IL-22","volume":"12","author":"Sonnenberg","year":"2011","journal-title":"Nat Immunol"},{"issue":"1","key":"2025010818032674100_ski274-bib-0028","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jaad.2020.02.069","article-title":"Cyclosporine for treatment of acute generalized exanthematous pustulosis: A retrospective analysis","volume":"83","author":"Yanes","year":"2020","journal-title":"J Am Acad Dermatol"}],"container-title":["Skin Health and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ski2.74","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ski2.74","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/skinhd\/article-pdf\/1\/4\/ski2.74\/59726345\/skinhd_1_4_e74.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/skinhd\/article-pdf\/1\/4\/ski2.74\/59726345\/skinhd_1_4_e74.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T18:03:42Z","timestamp":1736359422000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/skinhd\/article\/doi\/10.1002\/ski2.74\/7733966"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,15]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,12,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ski2.74","relation":{},"ISSN":["2690-442X"],"issn-type":[{"value":"2690-442X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,12]]},"published":{"date-parts":[[2021,11,15]]},"article-number":"ski2.74"}}