Allopurinol-induced DRESS syndrome

Abstract

A 70-year-old man was admitted to our clinic with complaints of fever, jaundice, dyspnea, and generalized rash after 3 months of allopurinol treatment for gout. On physical examination, he was found to have fever (38.5°C), jaundice, and generalized maculopapular rash. Leukocytosis, eosinophilia, elevation of liver enzymes, and hyperbilirubinemia were detected in his blood analysis. Skin biopsy was consistent with drug-induced hypersensitivity. He was diagnosed as Drug Rash with Eosinophilia and Systemic Symptoms (DRESS). Allopurinol treatment was stopped and steroid treatment was launched. At day 24 of admission, the patient died because of multiple organ failure.

Allopurinol Use and Risk of Fatal Hypersensitivity Reactions

“…Regarding the potential implications of our findings in other populations, allopurinol is a common drug that is associated with severe cutaneous adverse reactions in different ethnic groups, including Asians and Europeans. [3][4][5]8,11,27,[29][30][31] Epidemiological data, including the incidence and mortality of allopurinol hypersensitivity reported herein, are consistent with previous studies. [3][4][5]7,[10][11][12]32,33 Allopurinol hypersensitivity typically occurs in older patients with renal impairment in whom the dosage has not been appropriately reduced.…”

“…3 Drug rash with eosinophilia and systemic symptoms is a nonblistering cutaneous adverse reaction with systemic manifestations, including eosinophilia, leukocytosis, fever, hepatitis, and renal dysfunction. 8,9 In previous studies, 3,4,7 allopurinol hypersensitivity was found in 1 of 260 patients (approximately 0.4% of new users of allopurinol) and was a leading cause of severe cutaneous adverse reactions in several countries. Allopurinol hypersensitivity-related mortality was reported to be as high as 18% to 32%, and its long-term complications (eg, renal failure and eye sequelae) are frequently observed in survivors.…”

“…1,2 Although it is generally well tolerated, allopurinol is one of the most common drugs associated with life-threatening hypersensitivity reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms. [3][4][5][6][7][8] Stevens-Johnson syndrome and toxic epidermal necrolysis are variants of the same mucocutaneous blistering reaction disease and carry high morbidity and mortality. 3 Drug rash with eosinophilia and systemic symptoms is a nonblistering cutaneous adverse reaction with systemic manifestations, including eosinophilia, leukocytosis, fever, hepatitis, and renal dysfunction.…”

DRESS sendromlu 11 olgunun klinik özelliklerinin incelenmesi

“…Taiwan'da yapılan çalışmalarda en sık sorumlu olan ilacın DRESS hastalarının yaklaşık %31-37'sinde etkili olan allopurinol olduğu bildirilmiştir 10,11 . Ülkemizde de allopurinol kullanımına bağlı DRESS vakası bildirilmiştir 12 . Ülkemizde ayrıca karbamezepin, lamotrijin ve opipramol kullanımı ile ilişkili DRESS vakaları da tek olgular halinde bildirilmiştir [13][14][15] .…”

Hyperuricemia-Related Diseases and Xanthine Oxidoreductase (XOR) Inhibitors: An Overview

“…Importantly, it is one of the most common drugs associated with life-threatening hypersensitivity reactions, including bone marrow depression, hepatotoxicity, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis, and drug rash with eosinophilia and systemic manifestations [ 76 – 78 ]. These severe reactions with allopurinol occur in 0.1 to 0.4% patients, with a high mortality (27–32%) and a high morbidity, including renal failure and eye sequelae [ 77 , 79 ]. The hypersensitivity reaction may occur even after months or years of medication.…”