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Diagnosing dermatological disorders may be difficult, and subtle differences in their clinical features require a specific diagnostic competence to avoid incorrect interpretations. We do not agree with the diagnosis in a case that was reported by Carrillo-Jimenez et al¹ in the June 25, 2001, issue of the ARCHIVES.

The patient involved had a hyperacute rash with fever, asthenia, sore throat, chills, and polyarthralgia that had developed after 2 weeks of bupropion treatment. The skin lesions had a figurate appearance and were fiery red. Laboratory tests revealed only leukocytosis (white blood cell count, 14.3 x 10³/µL) with 91% neutrophils. Intravenous methylprednisolone therapy cleared the lesions in 24 hours. The diagnosis was erythema multiforme due to bupropion use.

We believe, however, that diagnosing toxic erythema multiforme would have required histopathological analysis, especially because in erythema multiforme the response to corticosteroids takes longer than 24 hours and because the development of neutrophilic . . . [Full Text of this Article]

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