Skin rash, eosinophilia, and renal impairment in a patient recently started on allopurinol

Jmeian, Ashraf; Hawatmeh, Amer; Shamoon, Razan; Shamoon, Fayez; Guma, Michael

doi:10.4103/2249-4863.192366

Cited by 7 publications

(3 citation statements)

References 6 publications

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“…concerning a case of allopurinol-related drug rash with eosinophilia and systemic symptoms (DRESS) in a patient of chronic kidney disease and gout, interesting. [ 1 ] The presence of eosinophilia, the temporal relationship of the symptoms with the initiation of treatment with allopurinol, and the marked improvement on withdrawal of the drug along with the administration of systemic corticosteroids were features suggesting the diagnosis of DRESS.…”

mentioning

confidence: 99%

Diagnostic criteria for drug rash and eosinophilia with systemic symptoms

Pannu

Saroch

2017

J Family Med Prim Care

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confidence: 99%

Diagnostic criteria for drug rash and eosinophilia with systemic symptoms

Pannu

Saroch

2017

J Family Med Prim Care

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“…However, drugs used to lower SUA, such as Xdh inhibitors (allopurinol Whelan et al, 1979 and febuxostat Becker et al, 2005 ) and uricosuric agents (probenecid Yonetani, Ishii & Iwaki, 1980 and benzbromarone Shinosaki et al, 1992 ), are highly dependent on absorption, which can lead to severe adverse reactions ( Hoyer et al, 2021 ; Jmeian et al, 2016 ; Lee et al, 2008 ). According to the guidelines recommended by the American College of Rheumatology (ACR) in 2020 ( FitzGerald et al, 2020 ), basic treatments, such as adjusting diet structure and restricting body weight, are important to lower SUA levels.…”

Section: Introductionmentioning

confidence: 99%

Dieting alleviates hyperuricemia and organ injuries in uricase-deficient rats via down-regulating cell cycle pathway

Yu,

Wan,

et al. 2023

PeerJ

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Dieting is a basic treatment for lowering hyperuricemia. Here, we aimed to determine the optimal amount of dietary food that lowers serum uric acid (SUA) without modifying the dietary ingredients in rats. Increased SUA was found in food-deprived 45-day-old uricase-deficient rats (Kunming-DY rats), and the optimal amount of dietary food (75% dietary intake) to lower SUA was established by controlling the amount of food given daily from 25% to 100% for 2 weeks. In addition to lowering SUA by approximately 22.5 ± 20.5%, the optimal amount of dietary food given for 2 weeks inhibited urine uric acid excretion, lowered the uric acid content in multiple organs, improved renal function, lowered serum triglyceride, alleviated organ injuries (e.g., liver, kidney and intestinal tract) at the histological level, and down-regulated the Kyoto Encyclopedia of Genes and Genome (KEGG) pathway of the cell cycle (ko04110). Taken together, these results demonstrate that 75% dietary food effectively lowers the SUA level without modifying dietary ingredients and alleviates the injuries resulting from uricase deficiency or hyperuricemia, the mechanism of which is associated with the down-regulation of the cell cycle pathway.

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“…Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare hypersensitivity reaction occurring in approximately 1/1000–1/10,000 of drug exposures, and is potentially fatal in up to 10–20% of cases [ 1 , 2 ]. The clinical manifestations of DRESS syndrome are not immediate and typically appear between 2 and 8 weeks after initiation of the triggering agent [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

DRESS syndrome in the setting of oxacillin therapy—a call for better patient preparedness: a case report

et al. 2021

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Background Drug reaction with eosinophilia and systemic symptoms syndrome is a rare but severe and potentially life-threatening hypersensitivity reaction, with significant morbidity and mortality. The clinical presentation of drug reaction with eosinophilia and systemic symptoms may include extensive skin rash, fever, lymphadenopathy, internal organ involvement, eosinophilia, and atypical lymphocytosis, most commonly due to drug-induced reaction. Our case is a rare occurrence of drug reaction with eosinophilia and systemic symptoms syndrome in the setting of oxacillin therapy. Case presentation A 55-year-old Caucasian male presented to the emergency department on account of acute onset, 2-day history of generalized pruritic rash with associated fever, occurring 3 weeks after commencing therapy with intravenous oxacillin for methicillin-sensitive Staphylococcus aureus bacteremia. He had no known drug allergies. Two days prior to hospitalization, he had a telehealth visit with the infectious diseases specialist on account of his rash, and was recommended to use oral diphenhydramine. However, with the onset of fever and persistence of his rash, he was advised to discontinue the oxacillin and present to the emergency department. On examination, he was febrile at 101.2 °F and had a generalized blanchable maculopapular and morbilliform rash involving the face, trunk, upper and lower extremities, but sparing the palms, soles, and oral mucosa. He had palpable nontender lymph nodes in the cervical and inguinal regions bilaterally. Laboratory studies revealed atypical lymphocytosis, eosinophilia, neutrophilia, and elevated serum transaminases. He was started on intravenous diphenhydramine and admitted to the in-patient medical service. On the second day of hospitalization, his fever resolved. However, his rash was persistent and generalized, as well as elevated transaminases and an abnormal cell count on the second day of hospitalization. To complete his 6-week course of antibiotics for methicillin-sensitive Staphylococcus aureus bacteremia, he was switched to an alternative therapy with cefazolin, and he was scheduled for weekly follow-up assessments following hospital discharge. Conclusions Healthcare providers should increasingly be aware of the significant morbidity and mortality attributable to drug reaction with eosinophilia and systemic symptoms syndrome and the potential medications which may incite such life-threatening reactions. Early recognition of drug reaction with eosinophilia and systemic symptoms syndrome and prompt institution of management strategies can promote improved clinical outcomes. Enhanced patient–provider communication strategies should be implemented to better prepare patients for the likelihood of such drug reactions, with the goal of improving patient-centered care and adherence with treatment strategies.

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Skin rash, eosinophilia, and renal impairment in a patient recently started on allopurinol

Cited by 7 publications

References 6 publications

Diagnostic criteria for drug rash and eosinophilia with systemic symptoms

Diagnostic criteria for drug rash and eosinophilia with systemic symptoms

Dieting alleviates hyperuricemia and organ injuries in uricase-deficient rats via down-regulating cell cycle pathway

DRESS syndrome in the setting of oxacillin therapy—a call for better patient preparedness: a case report

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