Delayed allergic reaction to Bupropion in a 56-year-old female: a case report and literature review

Delayed allergic reaction to Bupropion in a 56-year-old female: a case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Delayed allergic reaction to Bupropion in a 56-year-old female: a case report and literature review Hashem Alfakhoury, Razan Hassan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6953188/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract 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. Background Bupropion is a commonly prescribed medication for the treatment of major depressive disorder (MDD), seasonal affective disorder (SAD), and major anxiety. Owing to its high effectiveness and good tolerability, bupropion is also commonly used in smoking cessation programs [ 1 ]. The unusual mechanism of action of bupropion—exclusively blocking the reuptake of norepinephrine and dopamine with minimal direct serotonergic action—distinguishes it from other antidepressants [ 2 ]. Interestingly, compared with other selective serotonin reuptake inhibitors (SSRIs), the pharmacologic profile of bupropion is also associated with less sexual dysfunction and weight gain [ 3 ]. Clinical evidence suggests that bupropion is most often preferred for patients with anhedonia, low energy, or tiredness and is also most often used as an augmentation strategy following a partial response to SSRIs [ 4 ]. Although it is generally well tolerated, bupropion is reported to be associated with a range of adverse effects, most commonly insomnia, agitation, and dry mouth. Cutaneous hypersensitivity reactions are less common. Documented dermatologic side effects range from mild urticaria and pruritus to more severe presentations, such as angioedema or serum sickness–like reactions [ 5 , 6 ]. These reactions, if ever to occur, typically manifest within the first one to three weeks of treatment initiation of oral bupropion. However, delayed allergic responses—which may occur after the third week of treatment initiation—are rarely documented in the literature and can pose a diagnostic challenge. The delay of onset, coupled with nonspecific dermatologic symptoms, increases the risk of misdiagnosis, especially in patients with polypharmacy or existing dermatologic conditions [ 7 ]. This case report describes a 56-year-old woman who developed a delayed-onset allergic skin reaction approximately six weeks after initiating bupropion. Her presentation illustrates the importance of considering bupropion as a potential allergen even beyond the early treatment phase. In addition, we review related case literature to contextualize this clinical presentation and promote increased awareness among prescribing clinicians. Literature Review Although bupropion is generally well tolerated, a growing number of case reports in the literature have documented cutaneous (dermatologic) hypersensitivity reactions, including both early-onset and delayed presentations. The majority of reported cases range in severity from symptoms such as rash, pruritus, and urticaria, and, in more severe instances, angioedema and serum sickness–like reactions [ 8 , 9 ]. These reactions are typically immune-mediated and can represent either immediate-type hypersensitivity (Type I) or delayed-type (Type IV) responses [ 10 ], which represents the main focus of our case presentation. Delayed allergic reactions to bupropion remain relatively underreported and often escape early recognition. For example, a case reported by Bailey et al. described a delayed-onset hypersensitivity rash that developed approximately six weeks after initiating therapy [ 11 ]. The patient initially tolerated bupropion without incident, and the latency of the reaction contributed to diagnostic uncertainty. Similarly, Lertxundi et al. reported a case of bupropion-induced exanthematous pustulosis that appeared after several weeks of treatment, highlighting the unpredictable nature of such responses [ 12 ]. The mechanisms underlying these delayed hypersensitivity reactions are not fully understood but may involve T-cell–mediated immune responses, drug metabolite accumulation, individual variations in drug clearance, or a combination of these [ 13 ]. In many cases, these reactions resolve rapidly upon discontinuation of bupropion and initiation of supportive care, but failure to recognize the drug as the causative agent may prolong morbidity or lead to unnecessary diagnostic workup. Given that bupropion is often prescribed as monotherapy or in augmentation regimens, clinicians need to remain vigilant for adverse skin reactions throughout treatment—not just during the initial weeks. Timely identification and discontinuation of the offending agent can prevent progression and facilitate recovery. Case Presentation A 56-year-old single female sought specialized psychiatric evaluation due to symptoms consistent with childhood complex trauma and recurrent depressive disorder, including persistent low mood, anhedonia, anxiety, insomnia, and impaired functionality. The onset of symptoms appeared to be precipitated by significant psychosocial stressors, including interpersonal difficulties and increased occupational demands. The patient was started on escitalopram 5 mg, and the dose was gradually increased to 10 mg once daily after breakfast. She complained of weight gain and was evaluated by a psychiatrist to change therapy from escitalopram to bupropion gradually. She was started on 150 mg of bupropion sustained-release (SR), a tablet, once daily. The patient took bupropion as prescribed and was fully compliant. She took Bupropion at the same time daily for 20 days before any side effects were noticed. The patient denied any alcohol or tobacco use during the previous year. On day 20 after taking the medication, the patient presented to the medical emergency department for facial swelling, urticaria, and rash on the face, neck, chest, abdomen, and back. Other systemic manifestations included shortness of breath and dizziness when the patient was getting up from a seated position. At the ER, she was given the typical protocol for hypersensitivity reactions, as shown in Table 1 . Medication Route Typical Dose Notes Epinephrine (1:1000) IM 0.3–0.5 mg IM , For anaphylaxis and hypotension Diphenhydramine IV 25–50 mg H1 antihistamine Famotidine IV 20 mg H2 blocker; used adjunctively with H1 blocker Methylprednisolone IV 125 mg once To prevent late-phase reaction Normal Saline (0.9%) IV bolus 1–2 liters For hypotension Table 1: Medications and management of hypersensitivity reactions in the ER. On discharge, the cause of the allergic reaction was determined to be delayed hypersensitivity to bupropion. On discharge, bupropion was discontinued, and the medications listed in Table 2 were prescribed. Medication Class Dose Frequency Duration Purpose Prednisone Oral corticosteroid 40 mg Once daily (morning) 3–5 days (followed by short tapering) Preventing rebound allergic symptoms Fexofenadine H1 antihistamine 180 mg Once daily 5–7 days Long-acting and nonsedating antihistamine. Famotidine H2 blocker 20 mg Twice daily (3–5 days) Adjunct to H1 antihistamines for urticaria Table 2: Medications at discharge The patient revisited her psychiatrist, and oral prednisone was changed to oral deflazacort 30 mg daily (less potent and more tolerable). Further investigations revealed a personal history of mild psoriasis and a family history of autoimmune diseases, including multiple sclerosis (sister) and chronic spontaneous urticaria (CSU) (brother). The patient also had a history of lactose intolerance and followed a strict lactose-free and gluten-free diet. Tapering of Deflazacort 30 mg was initiated after 7 days of initiation, and the dose was changed to 15 mg of oral Deflazacort daily. Unexpectedly, dose tapering was followed by an acute exacerbation of urticaria and rash. The same protocol used for the first hospitalization was followed, and symptoms improved. Seven days later, oral deflazacort was further tapered to 7.5 mg, and another unexpected acute exacerbation followed but did not require hospitalization. Symptoms appeared to be alleviated the next day, and the patient reported no further episodes of urticaria. She was started on escitalopram, which she tolerated well with no issues. Discussion This case describes a delayed-onset hypersensitivity reaction to bupropion in a patient with no prior psychiatric medication history and no reported drug allergies. The reaction occurred on day 20 of therapy, outside the more commonly reported early-onset window [ 8 , 9 ], reinforcing the need for clinical vigilance beyond the initial period of drug initiation. The patient’s symptoms—diffuse urticaria, shortness of breath, and dizziness—are consistent with a systemic allergic reaction. While urticaria is a known but uncommon side effect of bupropion, the delayed presentation and recurrence after discontinuation point toward a T-cell–mediated immune response, characteristic of type IV hypersensitivity [ 10 , 13 ]. The failure of initial diphenhydramine therapy and the eventual need for systemic corticosteroids and epinephrine further underscore the severity of the reaction. Interestingly, the patient’s history of hypersensitivity to lactose and the family history of autoimmune disorders may suggest an underlying predisposition to immune-mediated responses. Individuals with a history of food allergies may have heightened immune reactivity, potentially increasing the risk of drug-induced allergic events [ 14 ]. While most hypersensitivity reactions to bupropion present within the first two weeks [ 5 , 9 ], this case aligns with a subset of delayed presentations reported in the literature, including that reported by Bailey et al., where onset occurred after six weeks of treatment [ 11 ]. In our patient, the reaction occurred sooner (day 20), suggesting a delayed yet not severely postponed onset and illustrating the variability in immune response timing. The resolution of symptoms after drug discontinuation and switching to escitalopram without incident further supports the diagnosis of bupropion-specific hypersensitivity. Notably, this case highlights the importance of a structured medication review and clinical history in assessing dermatologic complaints in psychiatric patients. Polypharmacy, comorbid allergies, and nonspecific symptoms can often obscure causality. Additionally, underreporting and limited awareness of rare adverse reactions may delay recognition and management [15]. Clinicians should educate patients initiating bupropion about both early and delayed allergic symptoms. Monitoring should extend beyond the first two weeks of therapy, particularly in patients with a personal or family history of hypersensitivity or autoimmune conditions. Prompt discontinuation of the suspected agent and initiation of supportive therapy remain the cornerstones of management. For patients requiring continued antidepressant treatment, transitioning to an alternative agent, such as escitalopram, as demonstrated here, may be both safe and effective. Conclusion This case highlights the potential for bupropion to cause hypersensitivity reactions that appear beyond the typical early treatment window. The development of symptoms after nearly three weeks of use, in the absence of prior drug allergies or psychiatric medication exposure, illustrates how individual immune variability can complicate clinical assessment. Given that a patient's personal and family history is suggestive of immune sensitivity, this reaction may reflect a predisposition to delayed-type allergic responses. The case highlights the importance of thorough medication review and patient history, particularly when dermatologic symptoms emerge during psychiatric treatment. Early recognition, withdrawal of the suspected agent, and appropriate medical support are essential. When ongoing antidepressant therapy is needed, switching to a well-tolerated alternative, such as escitalopram, can offer a safe path forward. Most importantly, patients should be informed of both immediate and delayed side effects, with monitoring extended beyond the first weeks of therapy. Declarations Ethics approval and consent to participate The case report involves a single patient, and institutional ethical approval was not required, as per local regulations and our institution's policies. Nonetheless, written informed consent for participation, including data collection and anonymized publication, was obtained from the patient before manuscript preparation. (Please refer to Appendix I ). Consent for publication Written informed consent was obtained from the patient for publication of this case report. The patient understands that personal details will be anonymized, but complete anonymity cannot be guaranteed. A copy of the signed consent form is available for review in Appendix I . Competing interests The authors affirm that neither they nor their immediate institutions have any financial or non‑financial interests that could be perceived to influence the findings or presentation of this case report. There are no grants, consultancies, patents, stock ownership, or speaker fees related to this work. Similarly, no personal, political, ideological, academic, or professional relationships could be viewed as a competing interest. This declaration is made following BMC’s requirements that all financial and non‑financial competing interests—or the lack thereof—must be disclosed to support editorial and peer-review transparency. Funding No external funding was received for the planning, conduct, authorship, or publication of this case report. All expenses—including manuscript preparation, submission fees, and related costs—were covered in full by the authors. Availability of data and materials All data generated or analyzed during this study are included in this published article and any supplementary files. No external datasets were used or created for this case report. If additional information is required, the corresponding author can provide further details upon reasonable request, subject to approval to protect patient confidentiality and privacy. This statement meets BMC’s requirement that data availability statements indicate where and how supporting data can be accessed. Acknowledgements We gratefully acknowledge the patient for providing informed consent and for their cooperation throughout this study. References Papakostas GI. Evidence for the efficacy of bupropion in the treatment of major depressive disorder. J Clin Psychiatry. 2006;67(Suppl 6):31–5. Ascher JA, Cole JO, Colin JN, Feighner JP, Ferris RM, Fibiger HC, et al. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995;56(9):395–401. Clayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63(4):357–66. Trivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354(12):1243–52. Khanna R, Gross GA, Fermo JD. Bupropion-induced urticaria: a case report and review. Ann Pharmacother. 2005;39(1):152–5. Goletiani N, Zhu H, Jablensky A. Cutaneous reactions to bupropion: case reports and literature review. Prim Care Companion J Clin Psychiatry. 2009;11(2):72–6. Bailey J, Talbot S, Holmes P. Delayed hypersensitivity to bupropion: a case report. BMJ Case Rep. 2012;2012:bcr2012006825. Roberge RJ, Hirani KH, Rowland PL. Angioedema associated with bupropion use. Ann Emerg Med. 2000;36(5):503–6. Fava M, Rush AJ, Thase ME, Clayton A, Stahl SM, Pradko JF, et al. 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim Care Companion J Clin Psychiatry. 2005;7(3):106–13. Vassileva S. Adverse cutaneous drug reactions. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick’s Dermatology. 9th ed. New York: McGraw Hill; 2019. pp. 1327–37. Lertxundi U, Hernandez R, Medrano J, Oribe M. Acute generalized exanthematous pustulosis induced by bupropion. Ann Pharmacother. 2007;41(6):1036–7. Pichler WJ. Drug hypersensitivity: classification and clinical features. In: Pichler WJ, editor. Drug Hypersensitivity. Basel: Karger; 2007. pp. 1–17. DeWitt AM, Grinnell VA, Weissman DN. Mango dermatitis: a case of urushiol-induced contact dermatitis. Dermatitis. 2011;22(3):170–2. Arimone Y, Bégaud B, Miremont-Salamé G, Fourrier A, Haramburu F, Molimard M, et al. Adverse drug reactions: physicians' opinions on their notification and the pharmacovigilance system. Eur J Clin Pharmacol. 2002;58(5):319–24. Additional Declarations No competing interests reported. Supplementary Files AppendixI.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 20 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviews received at journal 12 Jul, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviewers agreed at journal 03 Jul, 2025 Reviewers invited by journal 03 Jul, 2025 Editor invited by journal 25 Jun, 2025 Editor assigned by journal 24 Jun, 2025 Submission checks completed at journal 24 Jun, 2025 First submitted to journal 23 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6953188","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":481187491,"identity":"a915a0b2-83d2-4ea0-80f5-a4605eedffe3","order_by":0,"name":"Hashem Alfakhoury","email":"","orcid":"","institution":"Private clinic, Jordan","correspondingAuthor":false,"prefix":"","firstName":"Hashem","middleName":"","lastName":"Alfakhoury","suffix":""},{"id":481187492,"identity":"42a3afe8-eea8-44ef-b3c0-044069a1a4e9","order_by":1,"name":"Razan Hassan","email":"data:image/png;base64,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","orcid":"","institution":"Private clinic, Jordan","correspondingAuthor":true,"prefix":"","firstName":"Razan","middleName":"","lastName":"Hassan","suffix":""}],"badges":[],"createdAt":"2025-06-23 06:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6953188/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6953188/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86149348,"identity":"b31fb11a-4b39-44d0-b687-bbdd71b5eb4c","added_by":"auto","created_at":"2025-07-07 09:46:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":510678,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6953188/v1/fc5d5070-d03c-4914-ac9b-1f26e87ee7ac.pdf"},{"id":86148874,"identity":"6a12c490-e5ba-45cb-a2de-00a31b34c419","added_by":"auto","created_at":"2025-07-07 09:39:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21028,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixI.docx","url":"https://assets-eu.researchsquare.com/files/rs-6953188/v1/0f61f647da4e3b7f30e570b7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Delayed allergic reaction to Bupropion in a 56-year-old female: a case report and literature review","fulltext":[{"header":"Background","content":"\u003cp\u003eBupropion is a commonly prescribed medication for the treatment of major depressive disorder (MDD), seasonal affective disorder (SAD), and major anxiety. Owing to its high effectiveness and good tolerability, bupropion is also commonly used in smoking cessation programs [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The unusual mechanism of action of bupropion\u0026mdash;exclusively blocking the reuptake of norepinephrine and dopamine with minimal direct serotonergic action\u0026mdash;distinguishes it from other antidepressants [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Interestingly, compared with other selective serotonin reuptake inhibitors (SSRIs), the pharmacologic profile of bupropion is also associated with less sexual dysfunction and weight gain [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Clinical evidence suggests that bupropion is most often preferred for patients with anhedonia, low energy, or tiredness and is also most often used as an augmentation strategy following a partial response to SSRIs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough it is generally well tolerated, bupropion is reported to be associated with a range of adverse effects, most commonly insomnia, agitation, and dry mouth. Cutaneous hypersensitivity reactions are less common. Documented dermatologic side effects range from mild urticaria and pruritus to more severe presentations, such as angioedema or serum sickness\u0026ndash;like reactions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These reactions, if ever to occur, typically manifest within the first one to three weeks of treatment initiation of oral bupropion. However, delayed allergic responses\u0026mdash;which may occur after the third week of treatment initiation\u0026mdash;are rarely documented in the literature and can pose a diagnostic challenge. The delay of onset, coupled with nonspecific dermatologic symptoms, increases the risk of misdiagnosis, especially in patients with polypharmacy or existing dermatologic conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis case report describes a 56-year-old woman who developed a delayed-onset allergic skin reaction approximately six weeks after initiating bupropion. Her presentation illustrates the importance of considering bupropion as a potential allergen even beyond the early treatment phase. In addition, we review related case literature to contextualize this clinical presentation and promote increased awareness among prescribing clinicians.\u003c/p\u003e"},{"header":"Literature Review","content":"\u003cp\u003eAlthough bupropion is generally well tolerated, a growing number of case reports in the literature have documented cutaneous (dermatologic) hypersensitivity reactions, including both early-onset and delayed presentations. The majority of reported cases range in severity from symptoms such as rash, pruritus, and urticaria, and, in more severe instances, angioedema and serum sickness\u0026ndash;like reactions [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These reactions are typically immune-mediated and can represent either immediate-type hypersensitivity (Type I) or delayed-type (Type IV) responses [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which represents the main focus of our case presentation.\u003c/p\u003e \u003cp\u003eDelayed allergic reactions to bupropion remain relatively underreported and often escape early recognition. For example, a case reported by Bailey et al. described a delayed-onset hypersensitivity rash that developed approximately six weeks after initiating therapy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The patient initially tolerated bupropion without incident, and the latency of the reaction contributed to diagnostic uncertainty. Similarly, Lertxundi et al. reported a case of bupropion-induced exanthematous pustulosis that appeared after several weeks of treatment, highlighting the unpredictable nature of such responses [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mechanisms underlying these delayed hypersensitivity reactions are not fully understood but may involve T-cell\u0026ndash;mediated immune responses, drug metabolite accumulation, individual variations in drug clearance, or a combination of these [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In many cases, these reactions resolve rapidly upon discontinuation of bupropion and initiation of supportive care, but failure to recognize the drug as the causative agent may prolong morbidity or lead to unnecessary diagnostic workup.\u003c/p\u003e \u003cp\u003eGiven that bupropion is often prescribed as monotherapy or in augmentation regimens, clinicians need to remain vigilant for adverse skin reactions throughout treatment\u0026mdash;not just during the initial weeks. Timely identification and discontinuation of the offending agent can prevent progression and facilitate recovery.\u003c/p\u003e "},{"header":"Case Presentation","content":"\u003cp\u003eA 56-year-old single female sought specialized psychiatric evaluation due to symptoms consistent with childhood complex trauma and recurrent depressive disorder, including persistent low mood, anhedonia, anxiety, insomnia, and impaired functionality. The onset of symptoms appeared to be precipitated by significant psychosocial stressors, including interpersonal difficulties and increased occupational demands. The patient was started on escitalopram 5 mg, and the dose was gradually increased to 10 mg once daily after breakfast. She complained of weight gain and was evaluated by a psychiatrist to change therapy from escitalopram to bupropion gradually. She was started on 150 mg of bupropion sustained-release (SR), a tablet, once daily. The patient took bupropion as prescribed and was fully compliant. She took Bupropion at the same time daily for 20 days before any side effects were noticed. The patient denied any alcohol or tobacco use during the previous year. On day 20 after taking the medication, the patient presented to the medical emergency department for facial swelling, urticaria, and rash on the face, neck, chest, abdomen, and back. Other systemic manifestations included shortness of breath and dizziness when the patient was getting up from a seated position. At the ER, she was given the typical protocol for hypersensitivity reactions, as shown in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMedication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRoute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTypical Dose\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNotes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEpinephrine (1:1000)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e0.3–0.5 mg IM\u003c/strong\u003e,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFor anaphylaxis and hypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDiphenhydramine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e25–50 mg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eH1 antihistamine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFamotidine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e20 mg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eH2 blocker; used adjunctively with H1 blocker\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMethylprednisolone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e125 mg once\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTo prevent late-phase reaction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNormal Saline (0.9%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIV bolus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e1–2 liters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFor hypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Medications and management of hypersensitivity reactions in the ER.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn discharge, the cause of the allergic reaction was determined to be delayed hypersensitivity to bupropion. On discharge, bupropion was discontinued, and the medications listed in \u003cstrong\u003eTable 2\u003c/strong\u003e were prescribed.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMedication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eClass\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDose\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDuration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrednisone\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOral corticosteroid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOnce daily (morning)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3–5 days (followed by short tapering)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePreventing rebound allergic symptoms\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFexofenadine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eH1 antihistamine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e180 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOnce daily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5–7 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLong-acting and nonsedating antihistamine.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFamotidine\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eH2 blocker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 mg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTwice daily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(3–5 days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAdjunct to H1 antihistamines for urticaria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Medications at discharge\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient revisited her psychiatrist, and oral prednisone was changed to oral deflazacort 30 mg daily (less potent and more tolerable).\u003c/p\u003e\n\u003cp\u003eFurther investigations revealed a personal history of mild psoriasis and a family history of autoimmune diseases, including multiple sclerosis (sister) and chronic spontaneous urticaria (CSU) (brother). The patient also had a history of lactose intolerance and followed a strict lactose-free and gluten-free diet.\u003c/p\u003e\n\u003cp\u003eTapering of Deflazacort 30 mg was initiated after 7 days of initiation, and the dose was changed to 15 mg of oral Deflazacort daily. Unexpectedly, dose tapering was followed by an acute exacerbation of urticaria and rash. The same protocol used for the first hospitalization was followed, and symptoms improved. Seven days later, oral deflazacort was further tapered to 7.5 mg, and another unexpected acute exacerbation followed but did not require hospitalization.\u003c/p\u003e\n\u003cp\u003eSymptoms appeared to be alleviated the next day, and the patient reported no further episodes of urticaria. She was started on escitalopram, which she tolerated well with no issues.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis case describes a delayed-onset hypersensitivity reaction to bupropion in a patient with no prior psychiatric medication history and no reported drug allergies. The reaction occurred on day 20 of therapy, outside the more commonly reported early-onset window [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], reinforcing the need for clinical vigilance beyond the initial period of drug initiation.\u003c/p\u003e \u003cp\u003eThe patient\u0026rsquo;s symptoms\u0026mdash;diffuse urticaria, shortness of breath, and dizziness\u0026mdash;are consistent with a systemic allergic reaction. While urticaria is a known but uncommon side effect of bupropion, the delayed presentation and recurrence after discontinuation point toward a T-cell\u0026ndash;mediated immune response, characteristic of type IV hypersensitivity [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The failure of initial diphenhydramine therapy and the eventual need for systemic corticosteroids and epinephrine further underscore the severity of the reaction.\u003c/p\u003e \u003cp\u003eInterestingly, the patient\u0026rsquo;s history of hypersensitivity to lactose and the family history of autoimmune disorders may suggest an underlying predisposition to immune-mediated responses. Individuals with a history of food allergies may have heightened immune reactivity, potentially increasing the risk of drug-induced allergic events [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile most hypersensitivity reactions to bupropion present within the first two weeks [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], this case aligns with a subset of delayed presentations reported in the literature, including that reported by Bailey et al., where onset occurred after six weeks of treatment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In our patient, the reaction occurred sooner (day 20), suggesting a delayed yet not severely postponed onset and illustrating the variability in immune response timing. The resolution of symptoms after drug discontinuation and switching to escitalopram without incident further supports the diagnosis of bupropion-specific hypersensitivity.\u003c/p\u003e \u003cp\u003eNotably, this case highlights the importance of a structured medication review and clinical history in assessing dermatologic complaints in psychiatric patients. Polypharmacy, comorbid allergies, and nonspecific symptoms can often obscure causality. Additionally, underreporting and limited awareness of rare adverse reactions may delay recognition and management [15].\u003c/p\u003e \u003cp\u003eClinicians should educate patients initiating bupropion about both early and delayed allergic symptoms. Monitoring should extend beyond the first two weeks of therapy, particularly in patients with a personal or family history of hypersensitivity or autoimmune conditions. Prompt discontinuation of the suspected agent and initiation of supportive therapy remain the cornerstones of management. For patients requiring continued antidepressant treatment, transitioning to an alternative agent, such as escitalopram, as demonstrated here, may be both safe and effective.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the potential for bupropion to cause hypersensitivity reactions that appear beyond the typical early treatment window. The development of symptoms after nearly three weeks of use, in the absence of prior drug allergies or psychiatric medication exposure, illustrates how individual immune variability can complicate clinical assessment. Given that a patient's personal and family history is suggestive of immune sensitivity, this reaction may reflect a predisposition to delayed-type allergic responses. The case highlights the importance of thorough medication review and patient history, particularly when dermatologic symptoms emerge during psychiatric treatment. Early recognition, withdrawal of the suspected agent, and appropriate medical support are essential. When ongoing antidepressant therapy is needed, switching to a well-tolerated alternative, such as escitalopram, can offer a safe path forward. Most importantly, patients should be informed of both immediate and delayed side effects, with monitoring extended beyond the first weeks of therapy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThe case report involves a single patient, and institutional ethical approval was not required, as per local regulations and our institution's policies. Nonetheless, written informed consent for participation, including data collection and anonymized publication, was obtained from the patient before manuscript preparation. (Please refer to \u003cstrong\u003eAppendix I\u003c/strong\u003e).\u003c/p\u003e\n\u003ch3 id=\"_Toc201038124\"\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report. The patient understands that personal details will be anonymized, but complete anonymity cannot be guaranteed. A copy of the signed consent form is available for review in \u003cstrong\u003eAppendix I\u003c/strong\u003e.\u003c/p\u003e\n\u003ch3 id=\"_Toc201038125\"\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors affirm that neither they nor their immediate institutions have any financial or non‑financial interests that could be perceived to influence the findings or presentation of this case report. There are no grants, consultancies, patents, stock ownership, or speaker fees related to this work. Similarly, no personal, political, ideological, academic, or professional relationships could be viewed as a competing interest. This declaration is made following BMC’s requirements that all financial and non‑financial competing interests—or the lack thereof—must be disclosed to support editorial and peer-review transparency.\u003c/p\u003e\n\u003ch3 id=\"_Toc201038126\"\u003eFunding\u003c/h3\u003e\n\u003cp\u003eNo external funding was received for the planning, conduct, authorship, or publication of this case report. All expenses—including manuscript preparation, submission fees, and related costs—were covered in full by the authors.\u003c/p\u003e\n\u003ch3 id=\"_Toc201038127\"\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article and any supplementary files. No external datasets were used or created for this case report. If additional information is required, the corresponding author can provide further details upon reasonable request, subject to approval to protect patient confidentiality and privacy. This statement meets BMC’s requirement that data availability statements indicate where and how supporting data can be accessed.\u003c/p\u003e\n\u003ch3 id=\"_Toc201038128\"\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eWe gratefully acknowledge the patient for providing informed consent and for their cooperation throughout this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePapakostas GI. Evidence for the efficacy of bupropion in the treatment of major depressive disorder. J Clin Psychiatry. 2006;67(Suppl 6):31\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAscher JA, Cole JO, Colin JN, Feighner JP, Ferris RM, Fibiger HC, et al. Bupropion: a review of its mechanism of antidepressant activity. J Clin Psychiatry. 1995;56(9):395\u0026ndash;401.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClayton AH, Pradko JF, Croft HA, Montano CB, Leadbetter RA, Bolden-Watson C, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63(4):357\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTrivedi MH, Fava M, Wisniewski SR, Thase ME, Quitkin F, Warden D, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354(12):1243\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhanna R, Gross GA, Fermo JD. Bupropion-induced urticaria: a case report and review. Ann Pharmacother. 2005;39(1):152\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoletiani N, Zhu H, Jablensky A. Cutaneous reactions to bupropion: case reports and literature review. Prim Care Companion J Clin Psychiatry. 2009;11(2):72\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey J, Talbot S, Holmes P. Delayed hypersensitivity to bupropion: a case report. BMJ Case Rep. 2012;2012:bcr2012006825.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoberge RJ, Hirani KH, Rowland PL. Angioedema associated with bupropion use. Ann Emerg Med. 2000;36(5):503\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFava M, Rush AJ, Thase ME, Clayton A, Stahl SM, Pradko JF, et al. 15 years of clinical experience with bupropion HCl: from bupropion to bupropion SR to bupropion XL. Prim Care Companion J Clin Psychiatry. 2005;7(3):106\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVassileva S. Adverse cutaneous drug reactions. In: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, Orringer JS, editors. Fitzpatrick\u0026rsquo;s Dermatology. 9th ed. New York: McGraw Hill; 2019. pp. 1327\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLertxundi U, Hernandez R, Medrano J, Oribe M. Acute generalized exanthematous pustulosis induced by bupropion. Ann Pharmacother. 2007;41(6):1036\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePichler WJ. Drug hypersensitivity: classification and clinical features. In: Pichler WJ, editor. Drug Hypersensitivity. Basel: Karger; 2007. pp. 1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeWitt AM, Grinnell VA, Weissman DN. Mango dermatitis: a case of urushiol-induced contact dermatitis. Dermatitis. 2011;22(3):170\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArimone Y, B\u0026eacute;gaud B, Miremont-Salam\u0026eacute; G, Fourrier A, Haramburu F, Molimard M, et al. Adverse drug reactions: physicians' opinions on their notification and the pharmacovigilance system. Eur J Clin Pharmacol. 2002;58(5):319\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6953188/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6953188/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBupropion 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\u0026rsquo;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.\u003c/p\u003e","manuscriptTitle":"Delayed allergic reaction to Bupropion in a 56-year-old female: a case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-07 09:38:23","doi":"10.21203/rs.3.rs-6953188/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-20T06:39:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-20T00:58:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100878022219342097514211019017938918868","date":"2025-08-11T21:41:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-12T18:44:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"297781192003540588378820086203310683369","date":"2025-07-03T18:12:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236087638536973701827349676518119121586","date":"2025-07-03T10:02:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-03T09:00:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-25T07:27:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-24T07:47:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-24T07:47:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Medicine","date":"2025-06-23T05:56:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Medicine](https://link.springer.com/journal/44337)","snPcode":"44337","submissionUrl":"https://submission.springernature.com/new-submission/44337/3","title":"Discover Medicine","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a716e985-bfef-467d-9922-b213a8ed0396","owner":[],"postedDate":"July 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-16T06:23:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-07 09:38:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6953188","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6953188","identity":"rs-6953188","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}