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A Case Report of Clozapine-induced Symmetrical Drug-Related Intertriginous and Flexural Exanthema with cross-reactivity between Clozapine and Quetiapine

Published online by Cambridge University Press:  19 July 2023

S. C. Lim  and
A. Lijo
S. C. Lim*
Affiliation:
Psychiatry, Institute of Mental Health, Singapore
A. Lijo
Affiliation:
Psychiatry, Institute of Mental Health, Singapore
*
*Corresponding author.

Abstract

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Introduction

Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) is characterised by a distinctive pattern of erythematous and symmetrical rash over the gluteal and intertriginous regions after exposure to certain systemic medications. This is an uncommon condition which has been thought to be due to a Type IV delayed hypersensitivity reaction. Literature on clozapine-induced SDRIFE remains scarce, and reports of cross-reactivity among anti-psychotics are limited as well.

Objectives

To present a clinical case of Clozapine-induced SDRIFE with cross-reactivity between Clozapine and Quetiapine.

Methods

We describe a case of a lady with Treatment Resistant Schizophrenia who developed erythematous lesions with desquamation over her skin fold regions and buttocks within two months of Clozapine initiation.

Results

In our case, the lady was diagnosed with SDRIFE secondary to Clozapine. Clozapine was ceased, and the rashes resolved completely within a week. However, her psychiatric condition continued to worsened and she was trialed on Quetiapine. Unfortunately, she developed angioedema of the lips which necessitated a cessation of Quetiapine.

Conclusions

This case report illustrates the importance of recognising this rare condition, which can be readily treated by withdrawal of the culprit drug. Given that Clozapine and Quetiapine are structurally similar and fall under the class of Dibenzodiazepines, physicians should also be aware of the possibility of cross-reactivity among anti-psychotic medications leading to hypersensitive reactions.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 66 , Special Issue S1: Abstracts of the 31st European Congress of Psychiatry , March 2023 , pp. S1087 - S1088
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the European Psychiatric Association
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