title: Febuxostat-associated eosinophilic polymyositis in marginal zone lymphoma.
abstract: Febuxostat is an orally administered selective inhibitor of xanthine oxidase approved for the treatment of gout and prevention of tumor lysis syndrome. It is a relatively safe medication. Hypersensitivity reactions associated with the use of febuxostat are quite rare with only one reported case of DRESS syndrome. Recently, two case reports of rhabdomyolysis following the initiation of febuxostat were published. We hereby present the first case of rhabdomyolysis with hypereosinophilia following the administration of febuxostat to a 50-year-old patient newly diagnosed with marginal zone lymphoma. Three weeks after the initiation of febuxostat for tumor lysis syndrome prophylaxis, the patient presented with generalized weakness, diffuse myalgia and low-grade fever. Initial studies showed creatinine kinase level of 4471, hypereosinophilia of 1900/mm3, and LDH of 2691. All infectious and autoimmune diseases were ruled out. TSH level was normal. Muscle biopsy showed myonecrosis in addition to an eosinophilic inflammatory infiltrate in the endomysium and perimysium. Discontinuation of febuxostat led to prompt symptom resolution and normalization of blood tests eight days later.
authors.affiliation: Department of Hematology-Oncology, Faculty of Medicine, Saint-Jospeh university, Hotel-Dieu de France, Beirut, Lebanon.
authors.forename: Georges
authors.initials: G
authors.lastname: Chahine
authors.affiliation: Department of Hematology-Oncology, Faculty of Medicine, Saint-Jospeh university, Hotel-Dieu de France, Beirut, Lebanon; Gustave-Roussy Cancer Campus, 94800 Villejuif, France. Electronic address: Khalil_saleh@live.com.
authors.forename: Khalil
authors.initials: K
authors.lastname: Saleh
authors.affiliation: Department of Pathology, Faculty of Medicine, Saint-Joseph university, Hotel-Dieu de France, Beirut, Lebanon.
authors.forename: Claude
authors.initials: C
authors.lastname: Ghorra
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Saint-Joseph university, Hotel-Dieu de France, Beirut, Lebanon.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Khoury
authors.affiliation: Department of Hematology-Oncology, Faculty of Medicine, Saint-Jospeh university, Hotel-Dieu de France, Beirut, Lebanon; Gustave-Roussy Cancer Campus, 94800 Villejuif, France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Khalife
authors.affiliation: Department of Rheumatology, Faculty of Medicine, Saint-Joseph university, Hotel-Dieu de France, Beirut, Lebanon.
authors.forename: Fouad
authors.initials: F
authors.lastname: Fayad
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions; D004802:Eosinophilia / Q000139:chemically induced* / Q000209:etiology; D000069465:Febuxostat / Q000009:adverse effects* / Q000627:therapeutic use; D006074:Gout Suppressants / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017285:Polymyositis / Q000139:chemically induced / Q000209:etiology; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000209:etiology; D015275:Tumor Lysis Syndrome / Q000209:etiology / Q000517:prevention & control*
chemical_list: D006074:Gout Suppressants; D000069465:Febuxostat
keywords: Eosinophilic polymyositis; Febuxostat; Hypereosinophilia; Rhabdomyolysis