Energy-Dependent Rash Triggered by Bilateral Electroconvulsive Therapy: A Rare Case Report
A. Uzturk, I. H. Karakus, S. S. Kirlioglu BalciogluIntroduction
Electroconvulsive therapy (ECT) induces controlled seizures via electrical stimulation.It is used in severe or treatment-resistant depression, mania, schizophrenia, and schizoaffective disorder(American Psychiatric Association, 2025).Dermatological reactions to ECT are exceedingly rare.Kellner et al. (2015) reported ipsilateral hemifacial erythema during right unilateral ECT.To date, there have been no documented cases of erythematous rashes associated with bilateral ECT.
Objectives
We report a rare case of energy-dependent erythematous rash induced by bilateral temporal ECT.
Methods
A 29 year old woman with treatment-resistant paranoid schizophrenia was hospitalized for aggression, disorganized behavior, seeing images, and hearing voices.She had no history of ECT.On admission, she exhibited decreased self-care, disorganized thinking, irritability, auditory and visual hallucinations, persecutory and mystical delusions, impaired insight. Laboratory tests, urine toxicology, and cranial imaging were normal.
Results
Due to persistent psychotic symptoms despite adequate antipsychotic therapy, bilateral ECT was initiated.Over seven sessions, erythematous rashes appeared on the neck and chest within seconds of electrical stimulation. The rashes resolved within minutes following administration of corticosteroids and antihistamines. Allergy testing for anesthetic agents and latex (latex-specific IgE) yielded negative results. A notable pattern emerged; as the ECT stimulus energy increased, the rash became more pronounced, requiring higher doses or combined regimens of steroids and antihistamines (Table 1).No hemodynamic instability was observed, and ECT was otherwise well tolerated. Marked clinical improvement was noted, with PANSS scores improving from 116 to 75 and BPRS scores from 33 to 18.The patient regained partial insight and was discharged.