Lithium induced rash: a case report

Lithium remains the mainstay for treatment of acute and maintenance therapy of mania in bipolar disorder. The effectiveness of lithium should be weighed against its side effect profile. The cutaneous effects of lithium may occur at normal therapeutic serum lithium levels. Types of skin reactions associated with lithium include acne conglobata, hidradenitis suppurativa, folliculitis, alopecia, thinning of hair, macular/maculopapular rashes, and diffuse, erythematous, pruritic, maculopapular eruption. A 28 year old female patient, was admitted in our hospital with symptoms of irritability, decreased sleep, talking excessively, overfamiliarity, increased energy levels, increased sexual desire. Total duration of illness being 2 months. No past treatment history. Mental status examination shows overfamiliarity, overdressed, increased psychomotor activity, pressurized speech, flight of ideas and increased self esteem. She was diagnosed as first episode mania and was given tablet sodium valproate 1500 mg and tablet olanzapine 10mg in divided doses. Later lithium 300mg was added. 4 days after starting lithium patient developed maculopapular rash over both forearms, ventral aspect and nape of neck. There were no complaints of itching or any signs of systemic infection. Rash subsided completely within 5 days after stopping lithium. Clinicians should monitor cutaneous symptoms during lithium treatment, as lithium is associated cutaneous side effects, these may result in suboptimal adherence by the patients.