title: A dose-dependent delayed hypersensitivity reaction to acetaminophen after repeated acetaminophen intoxications.
abstract: We report a case of a 29-year-old woman with a borderline personality disorder who presented with intentional substantial acetaminophen (paracetamol) overdosage on nine occasions during a period of 21 months. In most cases, the patient presented at the hospital within 4 h after ingestion and was treated with gastric lavage, activated charcoal, laxatives and intravenous N-acetylcysteine. During the sixth overdosage the patient developed a rash on her chest and shoulders which was considered an anaphylactoid reaction to N-acetylcysteine. Therefore she was treated with oral methionine subsequently, but developed the rash again. The rash was then ascribed to the repeated high-doses of acetaminophen and treatment with N-acetylcysteine was reinstituted. This case shows that when an anaphylactoid reaction occurs after an acetaminophen overdose and treatment with N-acetylcysteine, acetaminophen must also be taken into account as the cause of the anaphylactoid reaction before effective therapy with N-acetylcysteine is withheld.
authors.affiliation: Slotervaart Hospital, Department of Pharmacy and Pharmacology, Amsterdam, The Netherlands.
authors.forename: A D
authors.initials: AD
authors.lastname: Huitema
authors.forename: M
authors.initials: M
authors.lastname: Soesan
authors.forename: P L
authors.initials: PL
authors.lastname: Meenhorst
authors.forename: C H
authors.initials: CH
authors.lastname: Koks
authors.forename: J H
authors.initials: JH
authors.lastname: Beijnen
mesh_terms: D000082:Acetaminophen / Q000506:poisoning*; D000111:Acetylcysteine / Q000627:therapeutic use; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000506:poisoning*; D004342:Drug Hypersensitivity; D005100:Expectorants / Q000627:therapeutic use; D005260:Female; D006801:Humans
chemical_list: D018712:Analgesics, Non-Narcotic; D005100:Expectorants; D000082:Acetaminophen; D000111:Acetylcysteine