Cutaneous Hypersensitivity Reactions to Bupropion: A Case Series

Background Bupropion, a norepinephrine–dopamine reuptake inhibitor, is widely prescribed for major depressive disorder (MDD). Cutaneous hypersensitivity reactions to bupropion — including urticaria, morbilliform eruptions, and serum sickness-like reactions — are recognized but infrequently characterized in psychiatric settings regarding onset pattern, severity spectrum, laboratory correlates, and management. Case Presentations We report three cases of cutaneous hypersensitivity reactions in young women (ages 24-27) initiated on bupropion XL 150 mg/day for MDD with avolitional features. Eruptions emerged between treatment days 5 and 17, presenting across a severity spectrum: Case 1 developed a urticarial eruption covering ∼18% body surface area (BSA); Case 2 presented with a morbilliform-to-urticarial eruption with periorbital edema and arthralgias; Case 3 developed the most severe presentation — a widespread maculopapular eruption covering 35-40% BSA with eosinophilia (10.8%) and histopathological confirmation of drug eruption, necessitating a 14-day inpatient admission. Eosinophil counts above the laboratory reference range were present in all three cases. Naranjo scores ranged from 6 to 7 (probable). Conclusions Bupropion-associated hypersensitivity reactions can manifest rapidly and encompass a wide severity spectrum. Elevated peripheral eosinophil counts appear to be a consistent early biomarker. Prompt drug discontinuation with severity-adapted antihistamine and corticosteroid therapy is associated with complete clinical resolution.