Macrolide Antibiotic-Induced Acute Generalized Exanthematous Pustulosis in an Epileptic Patient on Phenytoin Therapy

Acute Generalized Exanthematous Pustulosis (AGEP) is a rare and severe cutaneous adverse reaction characterized by the abrupt onset of widespread sterile pustules on an erythematous base. This is associated with medications, including antiepileptic drugs, phenytoin, and antibiotics such as beta-lactams and macrolides. This is a rare case where a macrolide antibiotic is reported to induce AGEP in an epileptic patient who was on phenytoin therapy. The patient, at the age of 25, was taking phenytoin for the past two years to subside epileptic symptoms. In this period, he has never reported any complications related to AGEP. Including macrolide antibiotics in his prescription aggravated the symptoms of AGEP within a few days. The primary course of action involved immediate withdrawal of both the drugs i.e. phenytoin and macrolide antibiotic, and symptomatic treatment.