LAUSR

Abstract Rationale: Acute generalized exanthematous pustulosis (AGEP) is a severe pustular cutaneous adverse drug reaction. Sterile, non-follicular pustules overlying the erythematous skin characterize this reaction. Patient concerns: A 30-year-old Asian women presented with sterile, non-follicular lesions with pus-fluid levels on her back 2 days after taking clindamycin. Skin biopsy revealed a spongiotic change in the epidermis with a focal subcorneal pustule and perivascular eosinophil and lymphocyte infiltration. Diagnosis: Clindamycin-induced AGEP. Interventions: We discontinued clindamycin treatment and prescribed systemic corticosteroids. Outcomes: The pustule stopped spreading within 1 day and the rash improved within 2 days. Lessons: AGEP is a pustular cutaneous adverse drug reaction that can appear with pus-fluid levels, clinically mimicking Sneddon–Wilkinson disease. The differentiation between both conditions is a history of drug use, characteristic skin lesions and histopathology.