Acute Generalized Exanthematius Pustulosis Caused by a Selective Allergy to Imipenem-Cilastatin: A Case Report

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Wichai Santimaleeworagun
Jantima Traipattanakul
Jatapat Hemapanpairoa


Acute generalized exanthematous pustulosis (AGEP) is acute onset of non-follicular, sterile pustules on an erythematous base. AGEP is commonly caused by drugs. A 65-year- woman, who suffered from systemic sclerosis, received 2 weeks of ertapenem and de-escalated to trimethoprim-sulfamethoxazole with good clinical outcome and no adverse reaction. During admission, this patient developed pneumonia and imipenem was initiated while trimethoprim-sulfamethoxazole was discontinued. This patient developed AGEP after 8 days of imipenem therapy and skin eruptions disappeared after imipenem administration finally ceased. This is a case of AGEP due to imipenem and no cross reaction to ertapenem. Nonetheless, re-challenge of other antipseudomonal carbapenems may be used cautiously.

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Santimaleeworagun W, Traipattanakul J, Hemapanpairoa J. Acute Generalized Exanthematius Pustulosis Caused by a Selective Allergy to Imipenem-Cilastatin: A Case Report. BKK Med J [Internet]. 2020 Feb. 25 [cited 2024 Apr. 23];16(1):74. Available from:
Case Report


Duong TA, Valeyrie-Allanore L, Wolkenstein P, et al. Severe cutaneous adverse reactions to drugs. Lancet 2017;390(10106):1996-2011.

Sidoroff A, Dunant A, Viboud C, et al. Risk factors for acute generalized exanthematous pustulosis (AGEP)-results of a multinational case-control study (EuroSCAR). Br J Dermatol 2007;157(5):989-96.

Szatkowski J, Schwartz RA. Acute generalized exanthematous pustulosis (AGEP): A review and update. J Am Acad Dermatol 2015;73(5):843-8.

Sidoroff A, Halevy S, Bavinck JN, et al. Acute generalized exanthematous pustulosis (AGEP)--a clinical reaction pattern. J Cutan Pathol 2001;28(3):113-9.

Hellinger WC, Brewer NS. Carbapenems and monobactams: imipenem, meropenem, and aztreonam. Mayo Clin Proc 1999;74(4):420-34.

Prescott WA, Jr., DePestel DD, Ellis JJ, et al. Incidence of carbapenem-associated allergic-type reactions among patients with versus patients without a reported penicillin allergy. Clin Infect Dis 2004;38(8):1102-7.

Zhanel GG, Wiebe R, Dilay L, et al. Comparative review of the carbapenems. Drugs 2007;67(7):1027-52.

Schrijvers R, Gilissen L, Chiriac AM, et al. Pathogenesis and diagnosis of delayed-type drug hypersensitivity reactions, from bedside to bench and back. Clin Transl Allergy 2015;5:31.

Feldmeyer L, Heidemeyer K, Yawalkar N. Acute Generalized Exanthematous Pustulosis: Pathogenesis, Genetic Background, Clinical Variants and Therapy. Int J Mol Sci 2016;17(8).

Bauer SL, Wall GC, Skoglund KJ, et al. Lack of cross- reactivity to meropenem in a patient with an allergy to imipenem-cilastatin. J Allergy Clin Immunol 2004;113(1):173-5.

Su P, Aw CW. Severe cutaneous adverse reactions in a local hospital setting: a 5-year retrospective study. Int J Dermatol 2014;53(11):1339-45.

Konyoung P, Tassaneeyakul W. Incidence of Drug induced-Acute Generalized Exanthematous Pustulosis (AGEP) Reported in Udonthani Hospital. Srinagarind Med J 2014;29(3):283-7.

Thienvibul C, Vachiramon V, Chanprapaph K. Five-Year Retrospective Review of Acute Generalized Exanthematous Pustulosis. Dermatol Res Pract 2015;2015:260928.

Livermore DM, Sefton AM, Scott GM. Properties and potential of ertapenem. J Antimicrob Chemother 2003;52(3):331-44.

Lakhal K, Lortat-Jacob B, Neukirch C, et al. Safe use of meropenem in a patient with a possible nonimmediate allergy to imipenem. Pharmacotherapy 2007;27(9):1334-8.

Noguerado-Mellado B, Pinto Fernández C, Pineda-Pineda R, et al. Cross-reactivity between carbapenems: Two case reports. J Allergy Clin Immunol Pract 2014;2(6):816-7.