Allopurinol-induced recurrent DRESS syndrome: pathophysiology and treatment.
Hyperuricemia is present in approximately 5% of the population. The vast majority is asymptomatic and at no clinical risk. Allopurinol, an analog of hypoxanthine, has been widely used in clinical practice for more than 30 years for the treatment of hyperuricemia and gout. Two percent of patients develop a mild exanthema when on this drug, which usually resolves after withdrawal of the drug. A syndrome characterized by exfoliative dermatitis, hepatitis, interstitial nephritis, and eosinophilia, termed allopurinol hypersensitivity syndrome, has been described, and its etiology related to the accumulation of one of allopurinol's metabolites, oxypurinol, of which clearance is decreased in the setting of renal insufficiency and the use of thiazide diuretics. The term DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) Syndrome has been recently used to describe an entity presenting with similar features.
Shalom
Rima
R
Department of Internal Medicine A, Haemek Medical Center, Afula, Technion, Faculty of Medicine, Haifa, Israel.
Rimbroth
Sofia
S
Rozenman
Dganit
D
Markel
Arie
A
D000368:Aged; D000493:Allopurinol / Q000009:adverse effects*; D003873:Dermatitis, Exfoliative / Q000139:chemically induced* / Q000188:drug therapy; D004802:Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy; D006074:Gout Suppressants / Q000009:adverse effects*; D006801:Humans; D033461:Hyperuricemia / Q000188:drug therapy; D008297:Male; D013577:Syndrome
D006074:Gout Suppressants; D000493:Allopurinol