Acute localized exanthematous pustulosis caused by systemic loxoscelism : a case report
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Introduction: Acute Localized Exanthematous Pustulosis (ALEP is a rare, benign cutaneous eruption characterized by localized pustules on an erythematous base. Typically, ALEP occurs as an adverse reaction triggered by specific medications, most notably B-lactam and macrolide antibiotics. However, in this case report, a 10 year old female presented with presumed ALEP secondary to developing systemic loxoscelism, systemic effects of a brown recluse spider bite (BRSB). Methods: Retrospective chart review of a patient presenting at the University of Missouri Hospital with a history of a BRSB. Data collected on the patient included demographics, lesion descriptions, clinical presentation, laboratory findings, and management. Results: A 10 year old female was admitted to the hospital with systemic symptoms including a peak fever of 38.1°C, fatigue, malaise, chills, nausea, hypotension, and diffuse erythematous blanching rash with pustules located on the dorsum of the left foot. Other abnormal lab values seen in our patient included leukocytosis with granulocyte predominance, elevated CRP, and anemia with normal LDH and haptoglobin (possible extravascular hemolysis). Conclusion: ALEP is a cutaneous adverse reaction is typically caused by certain medications. Proper identification, cessation of the offending agent if applicable, and appropriate supportive measures remain crucial in ALEP management. Because this case report is one of few systemic loxoscelism linked cases of ALEP, we hope this report will help provide some insight into this poorly understood condition.
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