Allopurinol-induced DRESS syndrome mimicking biliary obstruction.
An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8℃), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Hyung Gyu
HG
Choi
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Junsu
J
Byun
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Chae Ho
CH
Moon
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Jong Ho
JH
Yoon
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Ki Young
KY
Yang
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Su Cheol
SC
Park
Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea.
Chul Ju
CJ
Han
D000369:Aged, 80 and over; D000493:Allopurinol / Q000009:adverse effects; D001659:Biliary Tract / Q000473:pathology; D001660:Biliary Tract Diseases / Q000175:diagnosis; D001663:Bilirubin / Q000097:blood; D003401:Creatine / Q000097:blood; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology; D019160:Endosonography; D004804:Eosinophils / Q000166:cytology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D014057:Tomography, X-Ray Computed
D000493:Allopurinol; D003401:Creatine; D001663:Bilirubin
Allopurinol; DRESS syndrome; Jaundice