title: Acute Generalized Erythrodermic Pustular Psoriasis Associated with Bupropion/Naltrexone (Contrave®).
abstract: BACKGROUND
  We report a case of erythrodermic pustular psoriasis associated with initiation of bupropion/naltrexone (Contrave®; Orexigen Therapeutics, La Jolla, CA) in a patient with no history of psoriasis.
  
  
  METHODS
  A 55-year-old woman was transferred to our tertiary medical center from a community hospital for possible Stevens-Johnson syndrome 3 weeks after initiation of bupropion/naltrexone. The patient was admitted to the burn unit for wound treatment and hydration. She received intravenous cyclosporine during the admission that resulted in acute kidney injury and the therapy was discontinued. The skin biopsy ruled out Stevens-Johnson syndrome and was more consistent with generalized pustular psoriasis. After discharge, the patient followed up with her dermatologist. She was diagnosed with acute generalized and erythrodermic psoriasis and the patient was restarted on cyclosporine 100 mg twice a day. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Few case reports of bupropion-induced generalized pustular psoriasis and erythrodermic psoriasis in patients with a history of psoriasis have been reported. To our knowledge, acute generalized erythrodermic pustular psoriasis associated with bupropion/naltrexone has not been reported in a patient without history of psoriasis. Due to increases in obesity and increases in prescribing of bupropion/naltrexone SR, health care providers should be aware of this possible severe adverse reaction.
authors.affiliation: Department of Pharmaceutical Science, Erie County Medical Center, Buffalo, New York; Department of Emergency Medicine, Erie County Medical Center, Buffalo, New York.
authors.forename: Priyanka A
authors.initials: PA
authors.lastname: Singh
authors.affiliation: Department of Emergency Medicine, Erie County Medical Center, Buffalo, New York.
authors.forename: Kerry P
authors.initials: KP
authors.lastname: Cassel
authors.affiliation: Department of Emergency Medicine, Erie County Medical Center, Buffalo, New York.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Moscati
authors.affiliation: Department of Emergency Medicine, Erie County Medical Center, Buffalo, New York.
authors.forename: David
authors.initials: D
authors.lastname: Eckersley
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D001706:Biopsy / Q000379:methods; D016642:Bupropion / Q000009:adverse effects* / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003879:Dermatologic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000209:etiology; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009271:Naltrexone / Q000009:adverse effects* / Q000627:therapeutic use; D011565:Psoriasis / Q000209:etiology*; D013262:Stevens-Johnson Syndrome / Q000503:physiopathology
chemical_list: D003879:Dermatologic Agents; D016642:Bupropion; D009271:Naltrexone; D016572:Cyclosporine
keywords: bupropion; drug eruption; psoriasis