Case Report Pityriasis Rosea-like eruption associated with Clozapine: a case report Ya-Wen Lai, M.D. a , Che-Yi Chou, M.D. b , Winston W. Shen, M.D. a , Mong-Liang Lu, M.D., M.S. a, ⁎ a Department of Psychiatry, Taipei Medical University-Wan Fang Medical Center and School of Medicine, Taipei Medical University, Taipei, Taiwan b Departments of Dermatology, Taipei Medical University Hospital and School of Medicine, Taipei Medical University, Taipei, Taiwan Received 28 November 2011; accepted 5 March 2012 Abstract Adverse cutaneous drug reactions (ACDRs) are common in clinical practice and occur in about 5% of antipsychotic-treated patients. Most ACDRs are benign, but a small percentage of them are serious and life threatening. Pityriasis rosea (PR)-like eruption is a common cutaneous adverse reaction related to many drugs. Clozapine, a complex neurotransmitter receptor-binding in antipsychotic agent, is usually used for treatment-resistant schizophrenia. Clozapine-related ACDRs have been reported frequently, but clozapine-induced PR-like eruption has been reported once in the literature. We report a 54-year-old male patient with chronic schizophrenia who had received clozapine for 28 days and developed generalized skin rashes, high fever, and elevated values in liver function tests. His clozapine was immediately discontinued. He received acute managements with steroid and antihistamine, and his symptoms were relieved after treatment. This case report can be used to remind clinicians of keeping in mind the potential of clozapine-associated ACDRs. © 2012 Elsevier Inc. All rights reserved. Keywords: Clozapine; Pityriasis rosea; Adverse cutaneous drug reactions 1. Introduction Adverse cutaneous drug reactions (ACDRs), which are common in patients with antipsychotic treatments, have been reported to occur in about 5% of antipsychotic-treated patients [1]. Most ACDRs are benign and self-limited, but some of them are severe and life threatening. The mechanism of ACDRs associated with antipsychotic drug is still unclear and may be believed either immunological or non-immunological. Clinically clozapine-induced ACDRs have been reported with pruritus, exanthematous reactions, urticaria, photosen- sitivity, drug-induced pigmentation, erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrosis and drug hypersensitivity vasculitis [2]. Pityriasis rosea (PR) is a distinct papulosquamous skin eruption that typically affects children and young adults. It has been attributed to infections like viral and bacterial causes, certain drug expo- sures or rarely, vaccination [3]. Clinical presentations include a blossoming of bright red to violet, round or oval scaly plaques. To our knowledge, there is only one case report that described the association between PR-like eruption and clozapine treatment. Here we report another case of a patient who developed PR-like eruptions after clozapine administration. 2. Case report A 54-year-old single male patient had been diagnosed with chronic schizophrenia for 30 years. His psychotic symptoms were improved with trifluoperazine 30 mg daily, but he still had negative symptoms of schizophrenia. Thus trifluoperazine was gradually tapered off and finally stopped in 2 weeks. Clozapine was started with 25 mg daily and then was slowly increased to 300 mg daily in 4 weeks. The patient responded to clozapine treatment well, and he had improved significantly in his negative symptoms. However, he developed generalized skin rashes after having received a 4-week treatment with clozapine. Fig. 1 shows his numerous dermatologic lesions. He also devel- oped high fever up to 39.5°C 1 day after skin eruptions. His white cell count was 5740 cells/mm 3 , with 48% neutrophils, Available online at www.sciencedirect.com General Hospital Psychiatry 34 (2012) 703.e5 – 703.e7 ⁎ Corresponding author. Tel.: +886 2 29307930; fax: +886 2 29302448. E-mail address: mongliang@hotmail.com (M.-L. Lu). 0163-8343/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.genhosppsych.2012.03.002