Low-dose venlafaxine-induced erythema multiforme: a case report

Area of Science:

• Pharmacology
• Dermatology
• Geriatric Medicine

Background:

• Venlafaxine, a serotonin-norepinephrine reuptake inhibitor, is widely used for depression and anxiety.
• While generally safe, rare serious cutaneous reactions like erythema multiforme can occur.
• Elderly patients with polypharmacy may have increased risk for hypersensitivity reactions.

Purpose of the Study:

• To report the first known case of venlafaxine-induced erythema multiforme.
• To emphasize the importance of recognizing rare adverse drug reactions in psychiatric medication management.
• To highlight challenges in managing cutaneous drug reactions in elderly patients.

Main Methods:

• Case presentation of a 74-year-old male with generalized anxiety disorder.
• Initiation of low-dose venlafaxine leading to an erythematous, papular rash.
• Exclusion of differential diagnoses through clinical assessment; diagnosis supported by rapid symptom resolution upon drug withdrawal.

Main Results:

• The patient developed symptoms consistent with drug-induced erythema multiforme after starting venlafaxine.
• Other serious conditions like Stevens-Johnson syndrome were ruled out.
• Discontinuation of venlafaxine resulted in rapid improvement of the cutaneous reaction.

Conclusions:

• This case underscores the potential for rare, severe cutaneous reactions to venlafaxine, especially in elderly patients.
• Vigilance for adverse drug reactions is crucial, particularly when managing psychiatric medications in complex patients.
• Prompt identification and withdrawal of the offending drug are vital to prevent severe outcomes like Stevens-Johnson syndrome or toxic epidermal necrolysis.