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Human & Experimental Toxicology
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A dose-dependent delayed hypersensitivity reaction to acetaminophen after repeated acetaminophen intoxications

A DR Huitema

Slotervaart Hospital, Department of Pharmacy and Pharmacology, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

M Soesan

Slotervaart Hospital, Department of Internal Medicine, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

P L Meenhorst

Slotervaart Hospital, Department of Internal Medicine, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

C HW Koks

Slotervaart Hospital, Department of Pharmacy and Pharmacology, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

J H Beijnen

Slotervaart Hospital, Department of Pharmacy and Pharmacology, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands

We report a case of a 29-year-old woman with a borderline personality disorder who presented with intentional substantial acetaminophen (paracetamol) overdosage on nine occasions during a period of 21 months. In most cases, the patient presented at the hospital within 4 h after ingestion and was treated with gastric lavage, activated charcoal, laxatives and intravenous N-acetylcysteine. During the sixth overdosage the patient developed a rash on her chest and shoulders which was considered an anaphylactoid reaction to N-acetylcysteine. Therefore she was treated with oral methionine subsequently, but developed the rash again. The rash was then ascribed to the repeated high-doses of acetaminophen and treatment with N-acetylcysteine was reinstituted. This case shows that when an anaphylactoid reaction occurs after an acetaminophen overdose and treatment with N-acetylcysteine, acetaminophen must also be taken into account as the cause of the anaphylactoid reaction before effective therapy with N-acetylcysteine is withheld.

Key Words: acetaminophen • intoxication • hypersensitivity

Human & Experimental Toxicology, Vol. 17, No. 7, 406-408 (1998)
DOI: 10.1177/096032719801700708
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