# Posterior cervical instrumented fusion case complicated by acute generalized erythematous pustulosis

## TL;DR

A 74-year-old man developed a rare skin condition after cervical spine surgery, which improved with steroid treatment but led to a secondary infection.

## Contribution

First reported case of AGEP following cervical spinal surgery, highlighting its management and complications.

## Key findings

- AGEP was diagnosed after initial antibiotic treatment failed for a post-surgical rash.
- Topical steroids led to rapid improvement, but secondary wound infection required surgical debridement.
- AGEP is associated with IL36RN gene mutations and requires early recognition for effective treatment.

## Abstract

This case report describes the first case of acute generalised erythematous pustulosis (AGEP) following cervical spinal surgery. A 74-year-old male post-operatively developed a painful, exudative bullous rash progressing from the posterior cervical wound site. Initial management with antibiotics for suspected cellulitis failed, leading to further investigation and a diagnosis of AGEP by dermatology. Treatment with topical steroids resulted in rapid improvement, indicating the importance of early recognition and intervention. The patient developed secondary wound infection requiring surgical debridement. AGEP is linked to IL36RN gene mutations. This case underscores the necessity for clinicians to consider AGEP in peri-operative skin reactions, emphasizing early steroid intervention and vigilant monitoring for secondary infections.