CASE REPORT AND HISTORY
A 75-year-old African-American woman
with diabetes, hypertension, and hypothy-
roidism presented with a 3-day history of a
diffuse, pruritic, erythematous rash with
skin peeling (Figure 1). She had undergone
an exploratory laparotomy with jejunosto-
my for small bowel obstruction 2 months
prior to presentation. Her course was com-
plicated by an abdominal abscess for which
she had received intravenous (IV) cefazolin.
The abscess was surgically drained, and she
was discharged home to complete a course
of ciprofloxacin and metronidazole. Five
days into her course she developed an ery-
thematous rash that began on her back and
buttocks and spread within a day to cover
her entire body. The onset of rash was fol-
lowed by development of numerous small
pustules with areas of confluence (Figures 2
AND LABORATORY STUDIES
Physical examination revealed an afebrile,
obese woman with diffuse erythroderma, dis-
crete areas of superficial desquamation, and
small (<1 mm) pustules. Laboratory analysis
revealed a white blood cell count of
33 700/µL, a creatinine level of 3.0 mg/dL,
and a blood urea nitrogen level of 55 mg/dL.
Urinalysis showed numerous white blood
Acute Generalized Exanthematous Pustulosis
Jaime C. Robertson, MD, and LeAnn Coberly, MD
Dr Robertson is Resident in Internal Medicine, Department of Internal Medicine, University of Cincinnati College
of Medicine, Cincinnati, Ohio.
Dr Coberly is Associate Professor of Clinical Medicine, Department of Internal Medicine, University of
Cincinnati College of Medicine, Cincinnati, Ohio.
Drs Robertson and Coberly have reported they have no financial or advisory relationships with corporate orga-
nizations related to this activity.
Off-Label Product Discussion: The authors of this article do not include information on off-label use of products.
Correspondence to: LeAnn Coberly, MD, Department of Internal Medicine, University of Cincinnati College of
Medicine, 231 Albert Sabin Way, Mail Location 535, Cincinnati, OH 45267.