Abstract
Serum and red blood cell (RBC) cholinesterase activity testing has been mandatory in the State of California for agricultural pesticide applicators since 1989. The case of a worker with depressed cholinesterase activity levels is presented. When he started taking hydroxychloroquine for systemic lupus erythematosus his serum cholinesterase activity levels decreased and remained decreased while RBC activity levels remained unchanged. Sources of organophosphate exposure were ruled out and other possible causes of cholinesterase depression were excluded. The author postulates that hydroxychloroquine was responsible for the depression of serum cholinesterase activity levels.While this finding has no impact on those taking the drug, it does alert physicians managing a monitoring program to be aware of causes of cholinesterase activity depression other than organophosphate poisoning.
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