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WEI SONG, M.D., is Visiting Physician; and WILLIAM A. MILLER, M.D., is Attending Physician, Internal Medicine, California Pacific Medical Center, St. Luke’s Campus, San Francisco, CA.

Address correspondence to Dr. Miller at the Internal Medicine Department, California Pacific Medical Center, St. Luke’s Campus, San Francisco, CA 94110.

Purpose. A diffuse exanthema in a patient receiving varenicline is reported. Summary. A 71-year-old white woman, who was initially admitted to the hospital for elective vascular bypass surgery, had a three-day history of a diffuse rash, severe itching, and moderate headache. Her symptoms started two days before her admission. She denied having a fever, chills, nausea, vomiting, diarrhea, and flulike symptoms. She also denied having had contact with anyone who was ill, tick or insect bites, exposure to cats, or any changes in her diet, habits, or personal hygiene. Her medical problems included peripheral vascular disease, chronic obstructive pulmonary disease (COPD), dyslipidemia, hypertension, and hypothyroidism. In addition to several medications she had been taking for over 2 years, she had been taking varenicline as an aid for smoking cessation for eight days. The patient had been smoking for 40 years. The bright-red rash covered 70% of her torso and four extremities. She had mild swelling in her cheeks, but not on the eyelids or lips. Both of her lungs were clear on auscultation, with distant breath sounds caused by her COPD. Varenicline was discontinued, and her symptoms had completely resolved by the eighth day following discontinuation of the medication. While it is possible that other medications caused her symptoms, she had been taking most of them for over 2 years and all of them for over 1 year. Also, continuation of these drugs did not prevent her symptoms from resolving, nor did it cause a recurrence of the skin reaction. Conclusion. A patient developed diffuse exanthema after being treated with varenicline. Index terms: Drugs, adverse reactions; Exanthema; Geriatrics; Nicotinic agonists; Varenicline