Acute localized exanthematous pustulosis because of cefixime in a child: case report and review of pediatric cases

Acute Localized Exanthematous Pustulosis in a 5-Year-Old Boy With Zosteriform Distrubiton

Acute localized exanthematous pustulosis (ALEP) is typically a benign drug reaction that occurs shortly after drug intake. We report a five-year-old male who developed a localized, zosteriform pustular rash on his back 10 days after treatment with oseltamivir and ceftriaxone for an upper respiratory tract infection. The lesions, which appeared three days prior to presentation, were mildly itchy and resolved completely without scarring within two days of treatment with topical betamethasone valerate and fusidic acid. No bacterial growth was detected in the pustular culture. This case highlights the rare occurrence of ALEP in a pediatric patient and suggests variations from the EuroSCAR diagnostic criteria, which usually indicate a 72-hour onset post-drug intake, noting instead a 7-14 day onset in atypical cases.To best of our knowledge, This is the first report of ALEP presenting with a zosteriform distribution.

The Assessment and Efficiency of Cefixime in Upper Respiratory Tract Infections: Insights and Perspectives

Upper respiratory tract infections (URTIs) are common in patients of the pediatric age group and often lead to significant morbidity and mortality. Antibiotics such as cefixime have contributed to the management of URTIs, particularly when bacterial etiology is suspected. Several studies have evaluated the effectiveness of cefixime in pediatric URTIs, showing promising results in alleviating symptoms and reducing the duration of illness. Cefixime, a third-generation cephalosporin, exhibits broad-spectrum activity against common pathogens implicated in URTIs, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, which are resistant to hydrolysis by several β-lactamases. Due to its unique three-hour elimination half-life, cefixime allows for twice-daily or, in most cases, once-daily dosage. As a third-generation cephalosporin, cefixime effectively targets the common bacterial pathogens associated with these infections. Its notable efficacy is coupled with a favorable safety profile, making it a preferred choice for pediatricians and family physicians. The safety profiles of cefixime in children have been extensively studied with generally favorable outcomes. Adverse events are typically mild and infrequent, with gastrointestinal disturbances being most commonly reported. Notably, cefixime has a low propensity to induce bacterial resistance, making it a valuable option in the era of increasing antibiotic resistance. Cefixime may serve as a substitute for penicillin and first-generation cephalosporins in cases of acute upper and lower respiratory tract infections, acute otitis media, and acute uncomplicated urinary tract infections. This review aimed to provide a comprehensive outline of the use of cefixime in the treatment of URTIs in the pediatric population, focusing on its efficacy, safety, and overall clinical applications.

Acute Localized Exanthematous Pustulosis (ALEP) Caused by Topical Application of Minoxidil

Acute Localized Exanthematous Pustulosis (ALEP) is a rare skin reaction characterized by the sudden onset of multiple, small, sterile, non-follicular pustules in an erythematous and edematous base succeeding systemic drug administration. ALEP is considered a subtype of Acute Generalized Exanthematous Pustulosis (AGEP), although the exact pathogenic mechanism of the disease remains poorly defined. Numerous drugs have been implicated in the pathogenesis of ALEP, while contact mechanisms have also been reported. Herein, we describe the first case of ALEP attributed to minoxidil in a female patient with androgenetic alopecia. The positivity of patch tests and the topical application of minoxidil proposes a contact-induced hypersensitivity reaction. Identifying new agents-including minoxidil-which serve as inducers of drug-specific T-cell-mediated responses in the clinical spectrum of ALEP, adds further value in understanding the complex, yet unknown, pathophysiological mechanisms of this rare drug hypersensitivity reaction.