B. Bastola and LR. Bohora (2026). Carbamazepine-induced acute generalized exanthematous pustulosis triggering diabetic ketoacidosis in a patient with type II diabetes mellitus: a case report. Annals of medicine and surgery (2012), 88(2), 1949-1954. https://doi.org/10.1097/MS9.0000000000004623

PubMed 41675720

[Abstract]
INTRODUCTION AND IMPORTANCE: Acute generalized exanthematous pustulosis (AGEP) is a rare, severe cutaneous adverse drug reaction, typically triggered by antibiotics or anticonvulsants. Although carbamazepine is an uncommon cause, it was identified as the culprit in this case. Uniquely, the AGEP episode was complicated by diabetic ketoacidosis (DKA) in a patient with uncontrolled type II diabetes mellitus, with no identifiable trigger apart from the severe systemic inflammation associated with AGEP.

CASE PRESENTATION: A 54-year-old patient with multiple comorbidities developed AGEP shortly after initiating carbamazepine therapy for poststroke seizure. The condition was complicated by the onset of DKA. Systemic corticosteroids were administered to control cutaneous symptoms but caused transient worsening of glycemic control.

CASE DISCUSSION: Discontinuation of carbamazepine combined with standard DKA treatment resulted in full recovery. The case highlights the complexity of managing AGEP triggered by carbamazepine, especially when complicated by metabolic disturbances like DKA.

CONCLUSION: Carbamazepine-induced AGEP is an uncommon but serious reaction, which, in rare cases, can lead to DKA. The presence of both conditions simultaneously complicates treatment, as interventions for one may worsen the other. Effective management of these overlapping issues, particularly in patients with multiple health concerns, requires a cautious and collaborative approach.