Abstract
A 37-year-old man with a past history of drug eruption due to a Kampo (herbal) medicine took an over-the-counter drug including pseudoephedrine for nasal inflammation (Zikina®). The next day, erythematous macules and pustules developed over his whole body except his face. Laboratory data on the first examination showed leukocytosis. Histopathologically, a subcorneal pustule was noted in the biopsied specimen. Those eruptions were successfully treated with oral prednisolone (initial dose: 30mg/day) for 12 days. The drug lymphocyte stimulation test for Zikina® was negative. Patch testing with Zikina® and Maoto, a Kampo medicine including the herb ephedra, showed positive reactions at 48 and 72 hours. There were negative findings on patch tests with ingredients of Zikina® other than pseudoephedrine. Based on these findings, we diagnosed this patient as having acute generalized exanthematous pustulosis (AGEP) caused by pseudoephedrine in Zikina®. We advised the patient to avoid drugs containing pseudoephedrine and/or ephedra.
