A 49-year-old woman with no relevant medical history or recent drug use.
She presented dry cough of 5 days duration associated with odynophagia and pruritic lesions in the thighs.
Acute pharyngitis with scarlatin was diagnosed and treatment with oral lincomycin was initiated, without improvement of symptoms or remission of skin lesions.
After 48 h, fever was added up to 38.5°C and the lesions spread centrifugally, so he consulted again.
The patient was in regular general condition, hemodynamically stable.
Physical examination revealed mild pharyngeal erythema associated with a normal pulmonary examination.
No lymphadenopathy was investigated.
Skin examination revealed erythematous macules and erythematous papules palmoplantar and non-follicular, erythematous base, confluent in plaques, located in the neck, back, lumbar region.
Nikolsky's sign was negative.
There was no involvement of the oral, ocular or genital mucosa.
However, given the extensive cutaneous involvement, it was decided to admit the patient.
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Laboratory tests showed leukocytosis (15,500 neutrophils/mm3, neutrophils without neutrophils), neutrophils count (4-30 C-reactive protein) 14.7 mg/dL (normal value < 1 mg/dL), and alkaline phosphatase (GT25 IU/
The chest X-ray showed little interstitial infiltrate, with no foci of consolidation.
The molecular respiratory viral panel by polymerase chain reaction (PCR) technique was negative.
IgM for M. pneumoniae (qualitative technique by ELISA) was positive on the second day of hospitalization (corresponding to the ninth day of evolution).
Serology for HIV, hepatitis B virus, C virus, and syphilis were negative.
Gram stain and pustule current culture were negative.
A skin biopsy was performed in which the histopathological study showed acanthosis, spongiosis, exocytosis of neutrophils and intracorneal, intraepidermal and intrafollicular pustules.
The dermis showed a diffuse perivascular infiltrate with lymphocytes and neutrophils.
SAP staining was negative for microorganisms.
Given these clinical and histopathological findings, a diagnosis of AGEP was made, probably caused by M. pneumoniae.
Treatment was initiated with prednisone at a dose of 7 mg IV, at a dose of 50 mg administered every 8 h, and oral levofloxacin 400 mg daily, with an excellent evolution marked by fever and a decrease of 48 h.
After two weeks, the patient had no skin lesions.
