Delayed allergic reaction to bupropion presenting with dermatologic manifestations

Bupropion is a widely prescribed medication for the treatment of depression. Owing to its high effectiveness and good tolerability, bupropion is also commonly used in smoking cessation programs. Although uncommon, delayed hypersensitivity reactions associated with oral bupropion use can occur. We present here a case of a 56-year-old woman who developed diffuse urticaria, shortness of breath, and dizziness on day 20 of bupropion use. This unusual side effect necessitated immediate admission to the ER and the introduction of IV corticosteroids and epinephrine. Upon discontinuation of bupropion, the patient’s delayed-type hypersensitivity symptoms resolved; however, an oral maintenance regimen was implemented to mitigate the risk of recurrence. The patient subsequently transitioned to escitalopram and tolerated the treatment without incident.