52 year old female with a 3 year history of eczema, presented to the hospital approximately one week after starting treatment with tetracycline and prednisone for ocular pruritus. Her symptoms consisted of a diffuse pruritic blistering rash that gradually worsened.
Case Discussion
Drug eruption is an adverse drug reaction of the skin that can be generalized, as in this case. The diagnosis is mainly made from the medical history and clinical examination.
The biopsy reveals acute spongiosis with a mixed inflammatory infiltrate with eosinophil predominance and subcorneal pustulosis. These findings are consistent with a pustular drug reaction including acute generalized exanthematous pustulosis (AGEP).
AGEP is a skin eruption characterized by small pustules and pruritic erythroderma. It is associated with drug reactions, viral infections, and exposure to environmental agents such as mercury. On microscopy, there is epidermal spongiosis and subcorneal pustules that are filled with neutrophils. The dermis usually shows a lymphocytic and eosinophilic infiltrate.
This slide shows H&E stain. See Related Content for PAS stain.
Diaconescu, ED., Sade, S. Skin, drug eruption, H&E stain. Digital Laboratory Medicine Library, Dept of Laboratory Medicine & Pathobiology, University of Toronto. Published
. Accessed December 17, 2025. https://dev.dlml.cflabs.ca/image/skin-drug-eruption-he-stain-lmp75174
