title: [Allopurinol-induced DRESS complicated by hemophagocytic lymphohistiocytosis].
abstract: BACKGROUND
  Drug hypersensitivity syndrome is among the most severe drug hypersensitivity reactions and in rare cases it may progress to hemophagocytic lymphohistiocytosis. Herein, we report a case of allopurinol-induced drug reaction with eosinophilia and systemic symptoms complicated by hemophagocytic lymphohistiocytosis.
  
  
  METHODS
  An 18-year-old girl presented with maculopapular rash associated with cervical lymphadenopahy appearing 3 weeks after treatment with allopurinol. Her hemodynamic status at admission was unstable. Cutaneous examination revealed an itchy maculopapular rash, which was purpuric at certain sites, together with facial edema. The diagnosis of drug hypersensitivity was suggested and was confirmed by histological examination of a skin biopsy. Allopurinol was stopped. Two weeks later, however, eosinophilia was noted. Further, four days after discontinuation of allopurinol, in view of the laboratory signs of bicytopenia, hyponatremia, hypertriglyceridemia and hyperferritinaemia, as well as the presence of hemophagocytosis in bone marrow, a diagnosis was made of lymphohistiocytosis hemophagocytic syndrome complicating a drug reaction with eosinophilia and systemic symptoms. Moreover, viral serology tests were negative. The patient was given intravenous immunoglobulin and the outcome was good.
  
  
  CONCLUSIONS
  The literature contains only very few reports of drug reaction with eosinophilia and systemic symptoms complicated by hemophagocytic lymphohistiocytosis. The incriminated drugs were vancomycin, lamotrigine and phenobarbital. To our knowledge, there has only been one report of allopurinol-induced drug reaction with eosinophilia and systemic symptoms complicated by hemophagocytic lymphohistiocytosis.
authors.affiliation: Service de dermatologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie. Electronic address: korbimouna68@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Korbi
authors.affiliation: Service de dermatologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Youssef
authors.affiliation: Service des maladies infectieuses, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Ben Brahim
authors.affiliation: Département de pharmacologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: A
authors.initials: A
authors.lastname: Chaabane
authors.affiliation: Service de dermatologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: M
authors.initials: M
authors.lastname: Mohamed
authors.affiliation: Service de dermatologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Akkari
authors.affiliation: Service de dermatologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: H
authors.initials: H
authors.lastname: Belhadjali
authors.affiliation: Service de dermatologie, hôpital Fattouma-Bourguiba, 5000 Monastir, Tunisie.
authors.forename: J
authors.initials: J
authors.lastname: Zili
mesh_terms: D000293:Adolescent; D000493:Allopurinol / Q000009:adverse effects*; D063926:Drug Hypersensitivity Syndrome / Q000150:complications* / Q000209:etiology*; D005260:Female; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology*
chemical_list: D000493:Allopurinol
keywords: Allopurinol; DRESS; Hemophagocytic lymphohistiocytosis; Syndrome d’activation macrophagique; Syndrome d’hypersensibilité médicamenteuse