关键词: 急性泛发性发疹性脓疱病, 林可霉素, 药疹, 药物性肝损伤

Abstract: Huo Yuping, Chen Bojia, Chung Wenhung Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen 361026, China （Huo YP, Chen BJ）; Department of Dermatology, Chang Gung Memorial Hospital, Taipei 333, China （Chung WH） Corresponding author: Huo Yuping, Email: hhyp123@adm.cgmh.com.cn 【Abstract】 A 28-year-old male patient with coughing was treated with intramuscular injection of lincomycin, oral Kesouting granules and erythromycin in a local clinic. One day later, erythema occurred on the head and face, and rapidly spread to the trunk and limbs. Three days later, a large number of densely distributed needle tip- to millet-sized pustules occurred on the generalized erythema all over the body with fever and burning pain sensation of the skin. Skin examination revealed diffuse edematous erythema with obvious hyperemia on more than 90% of the body, a large number of needle tip- to millet-sized white-yellowish pustules on the erythema on the hair line, face, flexor aspect of the extremities and flexural site of the trunk （axillary and inguinal regions）, and bilateral lower-extremity swelling. No erythema or erosion was observed on the oral mucosa or genital mucosa. Histopathological examination of skin lesions on the right elbow showed local intraepidermal and subcorneal pustules, necrotic keratinocytes and neutrophil aggregation in the pustules, and infiltration of lymphocytes and eosinophils in the superficial dermis. Laboratory examination showed elevated white blood cell counts （26.9 × 109/L）, neutrophils proportion （Segment, 0.88）, C-reactive protein level （127.89 mg/L）, aspartate aminotransferase level （44.2 U/L） and alanine transarninase level （77.3 U/L）, but decreased proportion of lymphocytes （0.08）. The patient was diagnosed with acute generalized exanthematous pustulosis. After admission, the patient was treated with intravenous drips of methylprednisolone at a dose of 60 mg/d. Then, the condition was rapidly relieved, and the dosage was rapidly reduced. The patient was discharged on day 7.

Key words: Acute generalized exanthematous pustulosis, Lincomycin, Drug eruptions, Drug?induced liver injury