Cefoperazone-sulbactam-induced acute localized exanthematous pustulosis: A rare adverse drug reaction

Acute localized exanthematous pustulosis (ALEP) is a rare, localized form of acute generalized exanthematous pustulosis, commonly induced by antibiotics. We present a 28-year-old female who developed multiple sterile, non-follicular pustules on her face after receiving cefoperazone–sulbactam for a surgical site infection. The lesions appeared within 2 days of antibiotic initiation, without fever or systemic symptoms. Gram stain and potassium hydroxide examination were negative, ruling out infections. Based on the clinical presentation, rapid onset, and exclusion of other causes, a diagnosis of ALEP was made. Management involved discontinuation of the suspected antibiotics, saline compresses, and a short course of topical steroid-antibiotic therapy. The patient showed marked improvement within days. This case underscores the importance of recognizing ALEP in the differential diagnosis of acute pustular eruptions. Early identification and prompt drug withdrawal are essential for favorable outcomes and avoiding unnecessary interventions.