Acute generalized exanthematous pustulosis induced by amoxicillin-clavulanate in a child: the diagnostic utility of ultraviolet dermoscopy.

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a rare, acute pustular drug reaction, most commonly triggered by β‑lactam antibiotics. In children, early clinical features may overlap with infectious exanthems, leading to diagnostic uncertainty. We report a case of amoxicillin–clavulanate–induced AGEP developing in temporal succession after a scarlet fever–like illness in a six‑year‑old girl, with emphasis on the diagnostic contribution of ultraviolet (UV) dermoscopy. The child initially presented with fever, diffuse erythema with flexural accentuation, and strawberry tongue. Following initiation of amoxicillin–clavulanate, she developed multiple non‑follicular sterile pustules predominantly involving the bilateral axillae and groin within 24 hours. Dermoscopy revealed whitish to yellowish structureless pustules, while UV dermoscopy demonstrated multiple discrete to confluent yellow‑green fluorescent pustules on a dark background. Withdrawal of the offending drug resulted in rapid resolution with superficial desquamation. This report highlights the role of UV dermoscopy as a useful bedside adjunct in the early recognition of AGEP in pediatric patients.