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Severe cutaneous adverse reactions (SCARs) including acute generalized exanthematous pustulosis (AGEP) are usually medication-related and represent a rare, heterogeneous group of T-cell-triggered delayed hypersensitivity reactions resulting from interactions between small molecule drugs, human leucocyte antigen (HLA) Class I molecules, and T-cell receptors (TCR) [1,2,3,4,5].
A 62-year-old male patient with an anaplastic large T-cell lymphoma in medical history presented in our clinic with an abrupt onset of generalized maculopapular exanthema without mucosal involvement after initiating antibiotic therapy with a combination of caspofungin, vancomycin, and meropenem due to community-acquired pneumonia. A whole-body [18F]FDG PET/CT scan, performed four days after initial symptoms, demonstrated a very striking pattern of uniformly increased metabolic uptake throughout the skin. A marked [18F]FDG uptake was observed in the spine and spleen (SUVmax: 7,4) due to systemic inflammatory response. Moreover, the neck and groin areas exhibited also an intense tracer uptake (SUVmax: 7,3) mainly due to a partial volume effect and, to a lesser extent, physical stress in the skinfold areas in addition to the abovementioned dermatological changes. The elevated [18F]FDG uptake at the injection site in the right wrist is also to be mentioned. Skin biopsy revealed a superficial perivascular dermatitis with infiltration of the outermost layer of the dermis by lymphocytes, histiocytes, and single plasma cells, accompanied by focal parakeratosis and minimal spongiotic loosening of the stratum corneum (e).
To our best knowledge, this is the first metabolic imaging of SCAR syndrome, in particular meropenem-induced AGEP, using [18F]FDG PET/CT scan.
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FLG is a medical advisor for ABX, Advanced Biochemical Compound and Telix Pharmaceuticals. The other authors have no relevant financial or non-financial interests to disclose.
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Novruzov, E., Schmitt, D., Mori, Y. et al. Unique [18F]FDG PET imaging pattern of drug-induced acute generalized exanthematous pustulosis within the SCAR-spectrum. Eur J Nucl Med Mol Imaging 50, 1532–1533 (2023). https://doi.org/10.1007/s00259-022-06060-9
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DOI: https://doi.org/10.1007/s00259-022-06060-9