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

TL;DR

A 5-year-old boy developed a rare skin reaction resembling shingles after taking oseltamivir and ceftriaxone, resolving with topical treatment.

Contribution

This is the first reported case of ALEP with a zosteriform distribution in a pediatric patient.

Findings

The rash resolved completely within two days using topical betamethasone valerate and fusidic acid.

No bacterial growth was detected in the pustular culture.

The onset of ALEP occurred 7-14 days post-drug intake, differing from typical EuroSCAR criteria.

Abstract

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.

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