[Hypersensitivity reaction to allopurinol].
Major hypersensitivity reactions to allopurinol are rare. They are characterized by systemic vasculitis associated with a grave clinical picture. 20 days after beginning treatment with allopurinol, a 70-year-old patient presented with a maculo-papular, erythemato-squamous eruption which developed into erythroderma with fever, edema, polyadenopathy, marked eosinophilia, cholostatic jaudice, and aggravation of preexisting renal insufficiency. Skin biopsy showed vasculitis with fibrinoid necrosis and a chiefly lymphocytic infiltrate suggestive of a malignant lymphoma-type process. As soon as allopurinol was discontinued, and without steroid treatment, the patient spontaneously recovered. A lymphocyte transformation test was positive for this drug. The poorly know mechanism is immunological, with formation of immune complex deposits on the endothelial cells and at the dermo-epidermal junction, fibrinoid necrosis of small vessels and cellular reaction which is lymphocytic. It is not a toxic reaction related to the dose administered, though most authors have emphasized that preexisting renal insufficiency could favor hypersensitivity to allopurinol.
D000368:Aged; D000493:Allopurinol / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000276:immunology*; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000209:etiology
D000493:Allopurinol
Réaction d'hypersensibilité à l'allopurinol.