BACKGROUND: We report a case of erythrodermic pustular psoriasis associated with 
initiation of bupropion/naltrexone (Contrave®; Orexigen Therapeutics, La Jolla, 
CA) in a patient with no history of psoriasis.
CASE REPORT: A 55-year-old woman was transferred to our tertiary medical center 
from a community hospital for possible Stevens-Johnson syndrome 3 weeks after 
initiation of bupropion/naltrexone. The patient was admitted to the burn unit 
for wound treatment and hydration. She received intravenous cyclosporine during 
the admission that resulted in acute kidney injury and the therapy was 
discontinued. The skin biopsy ruled out Stevens-Johnson syndrome and was more 
consistent with generalized pustular psoriasis. After discharge, the patient 
followed up with her dermatologist. She was diagnosed with acute generalized and 
erythrodermic psoriasis and the patient was restarted on cyclosporine 100 mg 
twice a day. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Few case 
reports of bupropion-induced generalized pustular psoriasis and erythrodermic 
psoriasis in patients with a history of psoriasis have been reported. To our 
knowledge, acute generalized erythrodermic pustular psoriasis associated with 
bupropion/naltrexone has not been reported in a patient without history of 
psoriasis. Due to increases in obesity and increases in prescribing of 
bupropion/naltrexone SR, health care providers should be aware of this possible 
severe adverse reaction.