Toxic epidermal necrolysis, adverse reaction caused by allopurinol
A 75-year-old female patient presented with a mildly itching skin rash with associated symptoms of fever, shivering and weakness. According to the patient, the symptoms appeared approximately 3 days after she was prescribed allopurinol. The patient was diagnosed with toxic epidermal necrolysis.
Clinical examination showed a generalised maculopapular exanthema (a widespread rash that occurs on the outside of the body). The rash was recognised to be an adverse drug reaction. Therefore, allopurinol was discontinued. The patient was further put on ambulatory supportive therapy with prednisolone. He was also started on cetirizine. Both the medications did not help with any improvement in symptoms.
Soon after, the patient developed a progressive exanthema
The rash was painful, associated with widespread blistering, skin peeling, mucosal and conjunctival lesions. After presenting to the emergency department recurrently, the patient was referred to the intensive care unit (ICU). The patient’s symptoms were suggestive of toxic epidermal necrolysis. Doctors treated the patient with massive fluid replacement, cyclosporine and prednisolone. Local treatment with polyhexidine and octenidine were also advised. After 7 days of being in the ICU, the patient was referred to the Dermatology Department and was discharged on the 42nd day after admission.
The case study highlights the fact that the prescription of allopurinol is associated with potentially life-threatening complications. For example, Steven Johnson syndrome and toxic epidermal necrolysis. The patients should be immediately referred to dermatology and for multidisciplinary therapy. Toxic epidermal necrolysis is a skin-peeling disease that causes widespread erythema and epidermal blistering that may also be life-threatening.
Allopurinol is the first line of therapy for treatment of gout. Studies have shown that clinical practices tend to overcompensate treatment for asymptomatic patients with elevated serum urate. Consequently, this leads to serious and sometimes even life-threatening reactions.
Source: American Journal of Case Reports
