![]() Synovial fluid analysis showed noninflammatory effusion. This patient’s clinical course and features were consistent with drug-induced acute knee effusion. Analysis of the aspiration from her left knee revealed: white cell 430/mm 3, red cell 900/mm 3, polynuclear: 5/100 cells, mononuclear 95/100 cells and no gout/pseudogout crystals seen, suggesting noninflammatory effusion. After the fluid drainage, the effusion and swelling on her left knee disappeared and the effusion has never come back. After informed consent, around 15 ml yellow and hazy synovial fluid was drawn out from her left knee. Echocardiogram and venous Doppler of the left lower extremity were performed and results were normal. Lab tests: CBC, ESR, BNP (B-type natriuretic peptide), and D-dimer were normal. ![]() She denied suicidal and homicidal thoughts. She had pressured speech, loose associations, tangentiality and flights of ideas. On mental status examination: The patient was alert and oriented × 3, elevated in her affect and mood. The range of motion in both knees was normal. There was no effusion over her right knee. Her left knee revealed significant effusion and mild warmness without redness, tenderness or erythema. Her physical examination revealed that her vital signs were normal. She smokes one pack of cigarettes per day. She denies any substance abuse or alcohol abuse. She has had no known drug allergy or recent traumatic events. She denied any rash, fever, sore throat, or other systemic manifestations. The left knee remained swollen, but has not aggravated since then. Considering an adverse effect of bupropion, bupropion was discontinued. She complained of mild pain while walking and warmness of her left knee. The swelling was getting worse by the third week of taking bupropion XL. After two weeks, her left knee began to swell. Because her depression was out of control, bupropion XL 150 mg qd was administered. She was treated with Risperdal 1 mg qhs and Lamictal 50 mg qd for bipolar disorder, Klonopin 2 mg bid for anxiety and levothyroxine 25 mg qd for hypothyroidism. She was diagnosed with Bipolar I at 30 years. 2 In this report, we described an angioedema case presenting with highly unusual knee monoarthritis caused by bupropion.Ī 51 year old Caucasian lady with history of bipolar I disorder, anxiety disorder and hypothyroidism presented with a complaint that she had had left knee swelling for one week. It is also reported to cause anorexia, nausea, dry mouth, constipation, and weight loss by the activity of norepinephrine in the periphery. 4 The common side effects of bupropion XL are agitation, anxiety, and insomnia, caused by the activity of norepinephrine and dopamine in several brain areas. 1- 4 The extended-release preparation has been shown to be effective for treating geriatric depression, depression characterized by reduced energy, pleasure and interest, and the prevention of the recurrence of seasonal affective disorder. 1- 4īupropion is commonly prescribed for major depression, smoking cessation, bipolar depression, seasonal affective disorder, sexual dysfunction, and attention deficit hyperactivity disorder, with low incidences of somnolence, sexual dysfunction and weight gain. It also inhibits the uptake of serotonin and has moderate anticholinergic activity. 1 Bupropion can inhibit the presynaptic uptake of dopamine and norepinephrine and therefore boost neurotransmitters dopamine and norepinephrine. Bupropion hydrochloride (Wellbutrin, Aplenzin or Zyban) is an antidepressant of the aminoketone class, and its structure closely resembles that of diethylpropion.
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