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A 75-year-old woman developed during acute generalised exanthematous pustulosis (AGEP) off-label treatment with hydroxychloroquine for COVID-19 The woman presented with bilateral pneumonia due to COVID-19 infection She was initiated on treatment with off-label hydroxychloroquine [route and dosage not stated] Within 20 days of treatment initiation, she developed facial oedema and a pruriginous rash consisting of non-follicular pustules on an erythematous and edematous base located in flexural regions She did not show fever or mucosal involvement Her laboratory examinations were significant for leukocytosis and eosinophilia A histological examination of the punch biopsy showed non-follicular subcorneal pustules, neutrophilic exocytosis in the epidermis and mild-moderate diffuse spongiosis Moderate superficial oedema and mild mixed interstitial inflammation with lymphocytes and neutrophils, along with neutrophilic inflammation of eccrine ducts were noted on underlying dermis Based on the clinical findings, a diagnosis of AGEP was suspected The woman was treated with methylprednisolone, resulting in resolution of the widespread desquamation within 3-4 weeks Her AGEP was considered secondary to hydroxychloroquine treatment She was noted to have AGEP with overlapping features of DRESS, suggestive of wider clinical manifestations of AGEP in COVID-19 Suarez-Valle A, et al Comment on \'Generalized pustular figurate erythema: A newly delineated severe cutaneous drug reaction linked with hydroxychloroquine\': report of a COVID-19 patient with particular findings Dermatologic Therapy : 16 Jun 2020 Available from: URL: http://doi
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