Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel

Halevy, Sima; Ghislain, Pierre-Dominique; Mockenhaupt, Maja; Fagot, Jean-Paul; Bavinck, Jan Nico Bouwes; Sidoroff, Alexis; Naldi, Luigi; Dunant, Ariane; Viboud, Cécile; Roujeau, Jean‐Claude

doi:10.1016/j.jaad.2007.08.036

Cited by 420 publications

(366 citation statements)

References 22 publications

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“…It is well known that allopurinol dose increase leads to the more frequent occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Furthermore, the use of 200 mg or more of allopurinol daily was associated with a higher risk of SJS or TEN compared with lower daily doses, as reported by Halevy et al 8 . Th ere have been few case reports on skin granuloma annulare in patients as a side eff ect of allopurinol; however, to our knowledge, there are not many case reports on Pubmed on oral manifestations of allopurinol therapy.…”

Section: Discussionmentioning

confidence: 55%

Drug-Induced Oral Ulcerations: Case Report

Boras

Židovec-Lepej

Marinović

et al. 2016

ACC

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SUMMARY -A 70-year-old patient was admitted to the Department of Oral Medicine for multiple oral ulcerations on the left buccal mucosa, around 0.5 cm in diameter, as well as on the gingiva. Otherwise, the patient suff ered from chronic lymphocytic leukemia, hypogammaglobulinemia, chronic renal insuffi ciency, with complete afunction of the right kidney, asthma, hypertension, gastritis and prostate hyperplasia. Diff erential diagnosis of oral ulcerations included drug induced oral ulcerations, paraneoplastic pemphigus, viral ulcerations (cytomegalovirus, herpes simplex viruses), fungal ulcerations (candidiasis, aspergillosis, histoplasmosis, cryptococcosis) and bacterial ulcerations, as well as neutropenic ulcers. One of the possible explanations was that the lesions were due to the use of drugs, the more so as oral lesions evolved when the doses of allopurinol and chlorambucil were increased, and subsided when the doses of both drugs were decreased. However, we could not establish for sure whether the lesions were due to allopurinol or chlorambucil. According to literature data, allopurinol is one of the most frequent drugs known to induce skin adverse reactions, therefore we assumed that it was the culprit drug. Unfortunately, several weeks later the patient died from sepsis, pneumonia with respiratory insuffi ciency and multiorgan failure.

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Section: Discussionmentioning

confidence: 55%

Drug-Induced Oral Ulcerations: Case Report

Boras

Židovec-Lepej

Marinović

et al. 2016

ACC

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“…The EuroSCAR study revealed an increased risk of SJS/TEN at higher doses of allopurinol; adjusted odds ratio (OR) 36 for doses ≥200 mg daily compared with an adjusted OR 3.0 [1.1-8.4] for doses <200 mg daily [78]. This study also revealed that the risk was mostly confined to short-term use (≤8 weeks, unadjusted OR 261 [36-∞]).…”

Section: Pharmacokineticsmentioning

confidence: 69%

Severe Cutaneous Adverse Reactions

Fernando¹

2013

Skin Biopsy - Diagnosis and Treatment

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“…About 2% of the treated patients develop a skin rash, and some may experience severe drug hypersensitivity reaction [5]. A multinational study (EuroSCAR) revealed that allopurinol is the drug most commonly associated with Stevens-Johnson syndrome (SJS) or Toxic epidermal necrolysis (TEN) in Europe and Israel [6]. In a Korean study involving 38 patients with DRESS syndrome, allopurinol was found to be responsible for 5.3% of the cases [7].…”

Section: Case Reportmentioning

confidence: 99%

DRESS syndrome associated with allopurinol

Agu¹,

Basheer²

2014

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.com DRESS syndrome associated with allopurinolChidozie Charles Agu, Hiba Basheer ABSTRACT Introduction: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a severe drug reaction with an estimated mortality of up to 10% largely due to multi-organ dysfunction. Diagnosis is challenging because the extent of skin involvement does not always correlate with the extent of internal organ involvement and therefore early recognition of symptoms is vital to minimize morbidity and mortality. Management involves prompt cessation of the culprit drug, administration of corticosteroids and supportive treatment. Case Report: We report a case of an 87-year-old female with medical history significant for stage five chronic kidney disease, recently started on allopurinol for gout presented with dizziness, skin rash and eosinophilia which rapidly progressed to shock state followed by altered mentation, worsening renal failure, severe metabolic acidosis, deranged liver enzymes and gastrointestinal bleed requiring blood transfusion. Conclusion: Allopurinol is commonly used in clinical practice for the treatment of symptomatic hyperuricemia and gout. It has been associated with DRESS syndrome especially when used indiscriminately.

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Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel

Cited by 420 publications

References 22 publications

Drug-Induced Oral Ulcerations: Case Report

Drug-Induced Oral Ulcerations: Case Report

Severe Cutaneous Adverse Reactions

DRESS syndrome associated with allopurinol

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