{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:03:41Z","timestamp":1787497421099,"version":"build-2736575974"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science, Technological Development and Innovation","award":["451-03-34\/2026-03\/200111"],"award-info":[{"award-number":["451-03-34\/2026-03\/200111"]}]},{"award":["451-03-34\/2026-03\/200111"],"award-info":[{"award-number":["451-03-34\/2026-03\/200111"]}],"id":[{"id":"https:\/\/ror.org\/01znas443","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100031403","name":"University of Kragujevac","doi-asserted-by":"crossref","award":["No. 26\/25"],"award-info":[{"award-number":["No. 26\/25"]}],"id":[{"id":"10.13039\/100031403","id-type":"DOI","asserted-by":"crossref"}]},{"award":["No. 26\/25"],"award-info":[{"award-number":["No. 26\/25"]}],"id":[{"id":"https:\/\/ror.org\/04f7vj627","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dermatopathology"],"abstract":"<jats:p>Background\/Objectives: Hydroxychloroquine is widely used in the treatment of autoimmune and dermatologic diseases; however, it may rarely induce severe cutaneous adverse reactions. Acute Generalized Exanthematous Pustulosis is an uncommon, acute pustular eruption most frequently associated with antibiotics. Hydroxychloroquine-induced AGEP remains relatively rare and diagnostically challenging due to its atypical and prolonged clinical course. Case presentation: We report the case of a 45-year-old woman with rheumatoid arthritis and a complex medical history who developed generalized urticarial and pustular dermatosis following re-exposure to hydroxychloroquine. Notably, the patient had experienced a similar cutaneous reaction after previous exposure to the same medication several years earlier. Ten days after completing a treatment course of hydroxychloroquine, she developed rapidly progressive pruritic erythematous and urticarial plaques that evolved into generalized annular lesions with peripheral scaling and grouped sterile pustules. Laboratory evaluation demonstrated leukocytosis, intermittent eosinophilia, and elevated IgE levels, while the infectious workup was negative. Histopathological examination revealed subcorneal pustules with neutrophilic infiltration, mild spongiosis, and scattered individual eosinophils, perivascular inflammatory infiltrates, findings consistent with AGEP. Retrospective assessment using the EuroSCAR scoring system classified the reaction as probable AGEP, while the Naranjo adverse drug reaction scale supported a probable causal relationship with hydroxychloroquine. Clinical improvement was achieved after withdrawal of the drug and treatment with systemic corticosteroids and supportive therapy. Conclusions: This case highlights the importance of recognizing atypical presentations compatible with hydroxychloroquine-induced probable AGEP and emphasizes the diagnostic value of a positive rechallenge as supportive evidence of drug causality. Early recognition and prompt discontinuation of the offending agent are essential to prevent severe complications and recurrence.<\/jats:p>","DOI":"10.3390\/dermatopathology13030030","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:59:47Z","timestamp":1783065587000},"page":"30","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Hydroxychloroquine-Induced AGEP with Positive Rechallenge: A Case Report and Mini Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"given":"Kristijan","family":"Jovanovi\u0107","sequence":"first","affiliation":[{"name":"Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Center of Dermatovenereology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Umeljic So\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Center of Dermatovenereology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6740-0215","authenticated-orcid":false,"given":"Milos","family":"Stepovic","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jovana","family":"Milosavljevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7300-5385","authenticated-orcid":false,"given":"Jovica","family":"Tomovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3300-6199","authenticated-orcid":false,"given":"Miroslav M.","family":"Sovrli\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marko","family":"Foli\u0107","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Center for Pharmaceutical and Pharmacological Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1786-1507","authenticated-orcid":false,"given":"Milo\u0161 N.","family":"Milosavljevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and toxicology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8041-3491","authenticated-orcid":false,"given":"Dalibor","family":"Jovanovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9494-881X","authenticated-orcid":false,"given":"Nevena","family":"Foli\u0107","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia"},{"name":"Pediatric Clinic, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"ref_1","unstructured":"Stokkermans, T.J., Falkowitz, D.M., and Trichonas, G. 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