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Case report
An unusual bullous eruption: olanzapine induced pseudoporphyria
  1. Oliver Ross Johnson1,
  2. M Felicity Stewart2,
  3. Arti Bakshi3 and
  4. Philip Weston4
  1. 1 Internal Medicine, Royal Liverpool University Hospital, Liverpool, UK
  2. 2 Clinical Biochemistry, Salford Royal NHS Foundation Trust, Salford, UK
  3. 3 Histopathology, Royal Liverpool University Hospital, Liverpool, UK
  4. 4 Endocrinology, Royal Liverpool University Hospital, Liverpool, UK
  1. Correspondence to Dr Oliver Ross Johnson; oliverross.johnson{at}nhs.net

Abstract

A 27-year-old man with a background of schizophrenia presented during the summer months with a 2-day history of a blistering eruption predominantly affecting his hands, forearms and face. He had not knowingly been exposed to any chemicals or toxins and was otherwise well. Clinical examination revealed multiple, large, tense blisters affecting the sun-exposed sites. Histology subsequently demonstrated subepidermal blisters with minimal inflammation and negative immunofluorescence. Porphyrin biochemistry including faecal, urinary and serum samples were unremarkable and thus a diagnosis of pseudoporphyria was reached. There were no obvious triggers, however, olanzapine (an atypical antipsychotic) had been commenced 2 months previously and was deemed to be the most likely cause. This is the first report of pseudoporphyria being associated with an atypical antipsychotic and highlights the importance of eliciting an accurate drug history by specifically enquiring about any recent medication changes that could account for the clinical presentation.

  • dermatology
  • skin
  • metabolic disorders
  • unwanted effects / adverse reactions
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Footnotes

  • Contributors ORJ: responsible for literature review, first draft write-up and co-ordinating revision of the manuscript between the other co-authors. MFS: provided expert management advice on the case and also performed part of the literature review in relation to the clinical/diagnostic aspects of the porphyrias. Proof read and made amendments to be included in the final submitted version. AB: provided the written information and comments in relation to the histological aspects of the porphyrias. Helped with appropriate figure selection. Proof read and made amendments to be included in the final version. PW: responsible for leading the project and having overarching responsibility. PW was also responsible for conception of the case report as well as revision of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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