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Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: AGEP is characterized by non-follicular pustules on erythematous background along with fever, leukocytosis and histopathology characterized by spongiform intraepidermal pustules,papillary edema and polymorphous perivascular infiltrates with neutrophils. Methods: 38 year old male patient was brought to the ED after being found unresponsive at home. His trachea was intubated for airway protection and admitted to the ICU.Vancomycin, ceftriaxone and metronidazole were initiated for meningitis extending from his otitis media.He was started on scheduled olanzapine for recurrent agitation.Three days later he demonstrated erythema over his trunk and extremities that gradually involved face but sparing palms and soles.Three days later 1–2 mm pustules appeared along with fever and leukocytosis.Biopsy was performed one day after pustule appearance.Histopathology showed epidermal spongiosis with formation of intraepidermal pustules and scattered necrotic keratinocytes.The dermis showed perivascular and interstitial lymphocytic infiltrate along with neutrophils consistent with AGEP. During the medication review,temporality was noted with olanzapine, so olanzapine were discontinued and IV steroid initiated. The exanthema and edema improved after one day of steroids. Results: Type IV allergic reaction is the suggested mechanism of AGEP, although the exact mechanism is not clear. In addition to temporality being established with olanzapine, in our patient the pustules were sterile and the histology was similar to that in published literature. Drugs are responsible for 90% cases of AGEP. Patients usually present 1–3 weeks after introduction of offending agent though the latency period may be shortened to 2–3 days. Most common drugs are antimicrobials, carbamazepine, diltiazem and hydroxychloroquine. Other causes are viral infections, chemotherapy, and radiation. AGEP is a self-limiting disease and specific therapy is not available other than removal of offending agents. Antibiotics are not indicated unless there is superinfection of skin lesions. Corticosteroid treatment is also not necessary.