Abstract: Objective To analyze the clinical characteristics and potential allergenic mechanisms of atorvastatin induced severe generalized rash in patients with chronic diseases, providing a warning for future polypharmacy and reference for early clinical management. Methods A retrospective study was conducted on a patient with cerebral infarction who developed a generalized rash after polypharmacy (amlodipine, aspirin, atorvastatin, urinary kallidinogenase and edaravone dexborneol) was conducted. The rash worsened even after discontinuing urinary kallidinogenase and edaravone dexborneol and switching aspirin to clopidogrel. The rash subsided only after discontinuing all medications except for antiallergic drugs. When clopidogrel and amlodipine were reintroduced, the rash did not recur. The Naranjo score and literature review were used to analyze the potential allergenic drug. Results Based on the clinical presentation of the rash and its relationship with the timing of medication, combined with the Naranjo score of 5 for atorvastatin, it is very likely that atorvastatin is the drug causing the patient’s rash. Conclusions Clinicians should be aware that atorvastatin can cause severe generalized rash in chronic diseases patients a few days after administration during polypharmacy.

Key words: atorvastatin calcium, severe rash, cerebral infarction, adverse reaction, multiple drug, chronic disease management