A 60-year-old male with hypertension and hypercholesterolemia comes for a follow-up visit. His blood pressure in the office is 160/100 mmHg, and his readings are consistently elevated when he checks his blood pressure at home. An antihypertensive agent is added to his current regimen. He takes a brief vacation in Florida, and calls after a few days because he has developed an erythematous rash on the exposed parts of his body. Which of the following agents is most likely responsible for his rash?

Question

A 60-year-old male with hypertension and hypercholesterolemia comes for a follow-up visit.  His blood pressure in the office is 160/100 mmHg, and his readings are consistently elevated when he checks his blood pressure at home.  An antihypertensive agent is added to his current regimen.  He takes a brief vacation in Florida, and calls after a few days because he has developed an erythematous rash on the exposed parts of his body.  Which of the following agents is most likely responsible for his rash?

Quizplus · Accepted Answer

Explanation: The patient is likely to have a photosensitivity reaction, which is most commonly associated with the use of hydrochlorothiazide. Thiazides are sulfonamides; therefore, these can cause photosensitivity or generalized dermatitis. Treatment of the rash includes discontinuation of hydrochlorothiazide, use of sunscreen, and avoidance of sun exposure. (Choice A) Furosemide can cause a Stevens-Johnson syndrome type of reaction that is seen with the use of sulfonamide antibiotics. Urticarial rash can also occur; however, furosemide is not usually recommended for the management of hypertension alone. (Choice C) Lisinopril is an ACE inhibitor and can be associated with angioedema and urticaria. Photosensitivity rash is uncommon. Occasionally, lisinopril can lead to aggravation of psoriatic rash. (Choice D) Amlodipine therapy can be associated with significant fluid retention and urticarial rash. (Choice E) Metoprolol can cause urticaria in up to 5% of patients. Photosensitivity rash can occur, but it is much more uncommon compared to hydrochlorothiazide. Educational objective: Thiazides are sulfonamides; therefore, hydrochlorothiazide use can cause photosensitivity rash, and treatment of this rash includes discontinuation of the thiazide, use of sunscreen, and avoiding sun exposure.

A 60-Year-Old Male with Hypertension and Hypercholesterolemia Comes for a Follow-Up