Acute Generalized Exanthematous Pustular Dermatitis and Viral Infection

Three patients with acute generalized exanthematous pustular dermatitis (AGEPD) are presented. This new clinical entity comprises generalized erythema, erythema multiforme, amicrobial pustules, fever and spontaneous healing over a 10-day period. Histologically, there are a mixed neutrophilic and eosinophilic vasculitis and an eosinophilic subcorneal and spongiform pustule. All the patients experienced pharyngitis 1 week before the onset of the rash. Two of them had high-titered IgM-neutralizing antibodies to enteroviruses and 1 had an enterovirus in stool and urine. AGEPD may be related to a viral infection and may occur in patients with a genetic predisposition to psoriasis. The diagnosis of AGEPD should be made early enough so that the patients are not given the often aggressive therapy of pustular psoriasis.