A case report of hydroxychloroquine-induced auditory and visual hallucination

Abstract

Introduction: Discoid lupus erythematosus (DLE) is a common manifestation of lupus erythematosus. Hydroxychloroquine is commonly used in the treatment of lupus erythematosus. The present study aims to report hallucinations induced by hydroxy-chloroquine. Case presentation: A 37-year-old woman came to the dermatology clinic with a complaint of a red lesion on her left cheek. Physical examination revealed an ulcerative erythematous plaque with keratotic scales, an atrophic area of similar to 2 x 2.5 cm. Biopsy of the lesion was performed, and histopathology result was consistent with the diagnosis of DLE. Laboratory tests were all normal. Topical clobetasol and pimecrolimus were prescribed for the patient, who was recommended to use sunscreen as well. However, the treatment did not work, thus hydroxychloroquine 200 mg daily was added to the treatment. After a week, the patient came back to the clinic with her husband with the complaint of auditory and visual hallucinations, nightmares, and occasional decrease in consciousness level. After neurology and psychiatric consultation, hydroxychloroquine was discontinued and replaced with intralesional administration of triamcinolone. The lesion disappeared and did not recur. Discussion: Previous studies and the lack of another explanation for the patient's hallucinations imply a strong correlation between hydroxychloroquine and hallucinations. The mechanism of these side effects has not been fully elucidated. However, this side effect has only been reported in cases of connective tissue diseases. As currently hydroxy-chloroquine is widely used in the treatment of COVID-19 and other diseases, its potential risk of psychiatric complications should be considered in clinical practice.