Case Reports
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https://doi.org/10.4081/dr.2026.10286

Azathioprine-induced acute generalized exanthematous pustulosis in a woman with autoimmune hepatitis

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Received: 9 February 2025
Accepted: 29 March 2025
Published: 16 February 2026
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AGEP, azathioprine, pustulosis, drug-related reaction

Authors

Ilaria Scandagli
ilaria.scandagli@unifi.it
Department of Health Sciences, Section of Dermatology, University of Florence, Italy.
Elia Rosi
https://orcid.org/0000-0002-4227-7847
Department of Health Sciences, Section of Dermatology, University of Florence, Italy.
Daniela Massi
Department of Health Sciences, Section of Anatomic Pathology, University of Florence, Italy.
Francesca Prignano
https://orcid.org/0000-0002-5997-2045
Department of Health Sciences, Section of Dermatology, University of Florence, Italy.

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous drug reaction characterized by sterile pustules on erythematous skin. Azathioprine (AZA)-induced AGEP is rare, with few cases documented. We report a 50-year-old female with autoimmune hepatitis who developed a widespread pustular rash five days following the beginning of AZA therapy. Histopathology confirmed subcorneal pustules accompanied by eosinophilic infiltrates, indicative of AGEP. The discontinuation of AZA and systemic corticosteroids resulted in swift remission. This instance highlights the significance of prompt identification and discontinuation of medication to prevent adverse consequences.

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1.
Scandagli I, Rosi E, Massi D, Prignano F. Azathioprine-induced acute generalized exanthematous pustulosis in a woman with autoimmune hepatitis. Dermatol Reports [Internet]. 2026 Feb. 16 [cited 2026 Apr. 18];. Available from: https://journals.pagepress.net/dr/article/view/10286
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