Moxifloxacin-Induced Bullous Acute Generalized Exanthematous Pustulosis (AGEP): A Case Report of a Rare Clinical Presentation.

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction (SCAR) typically characterized by sterile pustules. The bullous variant of AGEP is exceptionally rare and represents a significant diagnostic challenge as it clinically mimics toxic epidermal necrolysis (TEN). We report the case of a 91-year-old woman who developed AGEP following moxifloxacin therapy, which rapidly progressed into a bullous form. A striking and rarely described clinical phenomenon-pustules developing directly on the roof of flaccid bullae-was observed. To our knowledge, this is the first reported case of the bullous variant of AGEP specifically triggered by moxifloxacin. Despite intensive treatment, the patient succumbed to sepsis on Day 15. This case underscores the importance of recognizing atypical AGEP presentations to avoid diagnostic confusion with Stevens-Johnson syndrome (SJS)/TEN and highlights a novel severe reaction to a widely used fluoroquinolone.