Lapatinib-induced acute generalized exanthematous pustulosis

Acute generalized exanthematous pustulosis (AGEP) is a pustular eruption, mainly drug induced often accompanied by fever and neutrophilic leukocytosis presenting as scarlatiniform erythema over the flexures evolving into numerous tiny non follicular pustules. We present a case report of a 56-year old woman, who had undergone mastectomy, treated with lapatinib for metastatic disease, and who presented with multiple erythematous papules and plaques with peripheral pustules. She also developed painful pyogenic granuloma-like lesions over the pulp of toe and over the proximal nail folds.All the lesions subsided following withdrawal of lapatinib. Although AGEP has been reported with imatinib (a multikinase inhibitor), there have been no reports of serious reactions with lapatinib, an EGFR inhibitor. This case could represent the first case report of AGEP to the EGFR inhibitor, lapatinib.