allopurinol and Fever

The Drug Reaction with Eosinophilia and Systemic Symptom (DRESS) is a severe adverse drug-induced reaction. Diagnosing DRESS is challenging due to the diversity of cutaneous eruption and organs involved. We used the RegiSCAR scoring system that grades DRESS cases as "no," "possible," "probable," or "definite" to classify cases reported in the literature. We also analyzed the clinical course and treatments of the cases. A total of 44 drugs were associated with the 172 cases reported between January 1997 and May 2009 in PubMed and MEDLINE. The most frequently reported drug was carbamazepine, and the vast majority of cases were classified as "probable/definite" DRESS cases. Hypereosinophilia, liver involvement, fever, and lymphadenopathy were significantly associated with "probable/definite" DRESS cases, whereas skin rash was described in almost all of the cases, including "possible cases." Culprit drug withdrawal and corticosteroids constituted the mainstay of DRESS treatment. The outcome was death in 9 cases. However, no predictive factors for serious cases were found. This better knowledge of DRESS may contribute to improve the diagnosis and management of this syndrome in clinical practice.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; Allopurinol; Carbamazepine; Diagnosis, Differential; Drug Eruptions; Eosinophilia; Exanthema Subitum; Female; Fever; Herpesvirus 6, Human; Humans; Lymphatic Diseases; Male; Middle Aged; Syndrome; Treatment Outcome

DRESS syndrome (drug rash, eosinophilia and systemic symptoms) is an idiosyncratic drug reaction characterised by rash, fever, lymphadenopathy and internal organ involvement. The authors report a case of this syndrome presenting with fever, generalised pruritus, macular rash and cholestatic hepatitis during allopurinol treatment. This case resolved with drug withdrawal, but the death rate in the setting of hepatic failure can reach 10%. Rapid diagnosis is crucial as prompt withdrawal of the offending drug is the key of the treatment, while the potential role of corticosteroids remains controversial.

Topics: Aged, 80 and over; Allopurinol; Drug Eruptions; Eosinophilia; Female; Fever; Humans; Lymphatic Diseases; Syndrome

Topics: Allopurinol; Chemical and Drug Induced Liver Injury; Diabetes Mellitus, Type 2; Diuretics; Fever; Furosemide; Gout Suppressants; Granuloma; Humans; Hypercalcemia; Hyperuricemia; Male; Middle Aged

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening adverse drug reaction characterised by generalised skin rash, fever, lymph node enlargement and haematological abnormalities, in addition to multiorgan involvement. However, diagnosis can be challenging, with rare cases presenting as an acute abdomen.Its aetiopathogenesis is not fully understood but inefficient drug detoxification, deregulated immune responses, reactivation of host viruses and genetic predisposition appear to be important. Furthermore, it has been recently recognised that antibiotics may act as promoters of DRESS syndrome caused by another drug. We report the case of a 48-year-old man, receiving allopurinol, who developed DRESS syndrome, initially presenting with a cholecystitis-like acute abdomen that was triggered by antibiotics. This report also emphasises the utility of performing patch skin tests to establish drug imputability.

Topics: Abdominal Pain; Allopurinol; Cholecystitis; Diagnosis, Differential; Drug Hypersensitivity Syndrome; Fever; Gout Suppressants; Humans; Male; Middle Aged

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare condition with a mortality rate of up to 10%. Herein, we describe a case of DRESS syndrome secondary to allopurinol and which may have been precipitated by amoxicillin, the diagnostic challenge it represented and the successful treatment of the condition with corticosteroids.

Topics: Adrenal Cortex Hormones; Aged; Allopurinol; Amoxicillin; Drug Hypersensitivity Syndrome; Eosinophils; Female; Fever; Humans; Leukocyte Count; Recurrence

Topics: Allopurinol; Dermatitis, Atopic; Diagnosis, Differential; Drug Hypersensitivity Syndrome; Enzyme Inhibitors; Erythema Multiforme; Erythema Nodosum; Exanthema; Female; Fever; Humans; Middle Aged

The objective of this study was to estimate the association between adverse drug reactions (ADRs) and exposure to allopurinol maintenance doses higher than those in the 1984 suggested limits of Hande et al. adjusted for level of renal function.. We conducted a retrospective review of electronic health records of patients prescribed allopurinol from January 1, 2004, to June 30, 2011, to identify those who had a definite or possible ADR to allopurinol. The associations of ADRs with maintenance doses of allopurinol 1 to 1.5 times and more than 1.5 times the suggested limits of Hande et al. compared with doses within the suggested limits of Hande et al. were estimated using logistic regression models.. Of 4755 patients prescribed allopurinol, 2946 had a serum creatinine measured within 6 months of starting allopurinol, and of these, 1268 patients' records were reviewed. Forty-eight patients had a definite ADR to allopurinol, 2 of which were allopurinol hypersensitivity syndrome. The odds ratios of definite ADRs with maintenance doses of allopurinol 1.0 to 1.5 times and more than 1.5 times suggested compared with doses within suggested limits were, respectively, 1.42 (95% confidence interval [CI], 0.66-3.04) and 2.04 (95% CI, 0.87-4.77). Among those with an allopurinol maintenance dose more than 1.5 times suggested limits, the proportion of patients with a definite ADR was 2.6% (95% CI, 1.0%-5.2%).. There is no significant association of high maintenance doses of allopurinol with ADRs, and the absolute risk of ADRs at doses higher than 1.5 times the 1984 suggested limits of Hande et al. is low. Cautious, gradual increases in allopurinol maintenance doses above the suggested limits of Hande et al. are warranted if necessary to achieve a serum uric acid level less than 6 mg/dL.

Topics: Aged; Allopurinol; Creatinine; Diarrhea; Dose-Response Relationship, Drug; Drug Hypersensitivity; Eosinophilia; Female; Fever; Gout Suppressants; Humans; Logistic Models; Male; Middle Aged; Nausea; Retrospective Studies; Sex Factors; Stevens-Johnson Syndrome; Thrombocytopenia; Transaminases; Vomiting

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, severe adverse drug reaction. The aim of this study was to characterize the aetiology, clinical features, laboratory findings, and management of patients with DRESS, diagnosed from January 2005 to April 2010 in a tertiary centre in Thailand. Twenty-seven patients were included in the study with a mean age of 52 years. Phenytoin, allopurinol, and nevirapine were the most commonly implicated medications. Mean duration of drug administration before the onset of symptoms was 34 days. The latent period was longer for allopurinol (103 days) and shorter for nevirapine (10 days). Skin rash was seen in all patients, while fever and lymphadenopathy were found in 88.9% and 22.2%, respectively. Hepatic and haematological involvement were the two most common systemic complications, occurring in 96.3% and 85.2%, respectively. Most patients were treated with systemic corticosteroids, for a mean duration of 49 days. The mortality rate in this study was 3.7%. Early detection and discontinuation of the suspected drug are the key steps of management.

Topics: Adult; Aged; Aged, 80 and over; Allopurinol; Anti-HIV Agents; Anti-Inflammatory Agents; Anticonvulsants; Dexamethasone; Drug Eruptions; Edema; Enzyme Inhibitors; Eosinophilia; Face; Female; Fever; Humans; Liver; Male; Middle Aged; Nevirapine; Phenytoin; Prednisolone; Pruritus; Recurrence; Retrospective Studies; Thailand; Time Factors; Withholding Treatment; Young Adult

Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe life-threatening, drug-induced, systemic hypersensitivity reaction. We report two patients who developed DIHS during treatment for acute myeloid leukemia. Awareness of DIHS is necessary when systemic eruptions and high fever occur in leukemic patients, especially with rapid hematopoietic recovery after chemotherapies.

Topics: Aged; Allopurinol; Anti-Infective Agents; Antibodies, Viral; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Cytarabine; Drug Eruptions; Exanthema Subitum; Female; Fever; Hematopoiesis; Herpesvirus 6, Human; Histiocytosis; Humans; Idarubicin; Immunocompromised Host; Leukemia, Myeloid, Acute; Leukemia, Myelomonocytic, Acute; Leukemic Infiltration; Middle Aged; Skin; Virus Activation

Infection during the induction phase of childhood acute lymphoblastic leukemia (ALL) is a major cause of morbidity and mortality. Several studies have indicated that genetically determined low serum levels of mannose-binding lectin (MBL), a component of innate immunity, are associated with increased risk for infections in patients receiving chemotherapy. Thus, these patients have been proposed to be candidates for MBL replacement therapy.. In a population-based cohort of 137 children with ALL treated at a single pediatric hematology-oncology center with an almost identical chemotherapy regimen, we studied the relationship between polymorphisms in the MBL gene (MBL2) and the MBL2 promoter and the risk of infections during the first 50 d of induction therapy.. No increased frequency of infection was seen for the children with genotypes encoding serum low levels of MBL. A higher incidence of fever (P < 0.004), infectious events (P = 0.025), days with neutropenia (P < 0.001) and a higher frequency of antimicrobial therapy (P = 0.0007) were seen in the young age group (<2.5 yr) compared with the older age group (> or =2.5 yr), independent of the MBL genotype.. MBL deficiency did not influence the frequency of infections in children receiving induction chemotherapy for ALL, not even in the youngest children (<2.5 yr) whom we found to have the highest risk for infections.

Topics: Adolescent; Age Factors; Allopurinol; Anti-Infective Agents; Antineoplastic Combined Chemotherapy Protocols; Bacteremia; Candidiasis; Child; Child, Preschool; Cohort Studies; Disease Susceptibility; Doxorubicin; Female; Fever; Fungemia; Genotype; Humans; Immunity, Innate; Immunocompromised Host; Incidence; Infant; Infections; Male; Mannose-Binding Lectin; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Promoter Regions, Genetic; Remission Induction; Vincristine

We report a case of DRESS syndrome also called drug hypersensitivity reaction occurring a 47 years old Senegalese man who has been taking allopurinol for 3 months. That drug was prescribed for peripheric arthralgias associated to a hyperuricemia. He presented a generalised pruritus, cutaneous lesions, fever and facial oedema. On the biological examens, hyperleucocytosis with hypereosinophilia and hyperlymphocytosis associated to the presence of segmented basophiles. In addition, a hepatic cytolysis and cholestasis were documented. Liver ultrasound was normal. The hemocults were negative. These following serologies have been performed and were negative: hepatitis B and C, Epstein Barr-virus, cytomegalovirus, syphilis, toxoplasma and parvovirus B19. The anti-nuclear and anti-DNA antibodies were negative. A favourable clinical evolution was remarked after allopurinol treatment withdrawal. A desquamation occurred after 6 days and hemogram turned out to the normal as well as the hepatic tests after 2 weeks. The virologic examens performed 2 months later were unremarkable. This case point out the importance of the early diagnosis and quick withdrawal of the drug in order to prevent serious forms leading to the 10% of death.

Topics: Allopurinol; Antimetabolites; Arthralgia; Drug Eruptions; Edema; Fever; Humans; Hyperuricemia; Male; Middle Aged; Senegal; Syndrome

Topics: Acute Disease; Adult; Allopurinol; Antimetabolites; Antineoplastic Agents; Epistaxis; Fever; Fluid Therapy; Humans; Hydroxyurea; Leukapheresis; Leukemia, Myeloid; Leukocytosis; Male; Vision Disorders

This work tested the hypotheses that splanchnic oxidant generation is important in determining heat tolerance and that inappropriate.NO production may be involved in circulatory dysfunction with heat stroke. We monitored colonic temperature (T(c)), heart rate, mean arterial pressure, and splanchnic blood flow (SBF) in anesthetized rats exposed to 40 degrees C ambient temperature. Heating rate, heating time, and thermal load determined heat tolerance. Portal blood was regularly collected for determination of radical and endotoxin content. Elevating T(c) from 37 to 41.5 degrees C reduced SBF by 40% and stimulated production of the radicals ceruloplasmin, semiquinone, and penta-coordinate iron(II) nitrosyl-heme (heme-.NO). Portal endotoxin concentration rose from 28 to 59 pg/ml (P < 0.05). Compared with heat stress alone, heat plus treatment with the nitric oxide synthase (NOS) antagonist N(omega)-nitro-L-arginine methyl ester (L-NAME) dose dependently depressed heme-.NO production and increased ceruloplasmin and semiquinone levels. L-NAME also significantly reduced lowered SBF, increased portal endotoxin concentration, and reduced heat tolerance (P < 0.05). The NOS II and diamine oxidase antagonist aminoguanidine, the superoxide anion scavenger superoxide dismutase, and the xanthine oxidase antagonist allopurinol slowed the rates of heme-.NO production, decreased ceruloplasmin and semiquinone levels, and preserved SBF. However, only aminoguanidine and allopurinol improved heat tolerance, and only allpourinol eliminated the rise in portal endotoxin content. We conclude that hyperthermia stimulates xanthine oxidase production of reactive oxygen species that activate metals and limit heat tolerance by promoting circulatory and intestinal barrier dysfunction. In addition, intact NOS activity is required for normal stress tolerance, whereas overproduction of.NO may contribute to the nonprogrammed splanchnic dilation that precedes vascular collapse with heat stroke.

Topics: Allopurinol; Animals; Arginine; Blood Pressure; Electron Spin Resonance Spectroscopy; Endotoxemia; Enzyme Inhibitors; Fever; Free Radical Scavengers; Free Radicals; Guanidines; Heart Rate; Heat Stress Disorders; Intestinal Absorption; Male; Myocardium; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase; Oxidative Stress; Polyethylene Glycols; Portal Vein; Rats; Rats, Sprague-Dawley; Splanchnic Circulation; Substrate Specificity; Superoxide Dismutase

Topics: Allopurinol; Angioedema; Anti-Inflammatory Agents; Drug Eruptions; Fever; Gout Suppressants; Humans; Male; Methylprednisolone; Middle Aged

Topics: Allopurinol; Brain Diseases; Child; Diagnosis, Differential; Female; Fever; Heat Exhaustion; Humans; Hungary; Male; Shock, Hemorrhagic; Syndrome; Terminology as Topic

Topics: Adult; Aged; Allopurinol; Fever; Humans; Male

Topics: Allopurinol; Anti-Bacterial Agents; Body Temperature Regulation; Drug Hypersensitivity; Fever; Humans; Interleukin-1; Isoniazid; Methyldopa; Phenytoin; Procainamide; Quinidine

Topics: Aged; Allopurinol; Captopril; Drug Synergism; Fever; Humans; Joint Diseases; Male; Muscular Diseases; Pain; Proline

In clinical oncology emergency situations are either manifestations of the underlying disease or effects of the treatment. The successful treatment of emergency situations is not only important in diseases in which cure is possible. It contributes also essentially to an optimal palliation for not curable disease states in oncology. Some special examples from the point of view of internal medicine are briefly discussed.

Topics: Allopurinol; Bacterial Infections; Bleomycin; Cyclophosphamide; Emergencies; Fever; Fluid Therapy; Granulocytes; Humans; Hypercalcemia; Leukopenia; Lymphoma; Neoplasms; Spinal Cord Compression; Spinal Injuries; Spinal Neoplasms; Tetracyclines

Of 29 524 hospitalised medical patients monitored in a drug surveillance programme 1835 (6.2%) received the xanthine oxidase inhibitor allopurinol. After the exclusion of skin reactions adverse effects were attributed to this drug in 33 (1.8%) patients, the most frequent being haematological abnormalities (11 patients, 0.6%) and diarrhoea and drug fever (5 each, 0.3%). Adverse effects were dose-related. Reactions were unrelated to age, weight, reason for therapy, admission blood urea, or albumin concentrations. Acute exacerbation of gout was troublesome in 3 patients (1 in 600 exposed).

Topics: Aged; Allopurinol; Diarrhea; Dose-Response Relationship, Drug; Female; Fever; Hematologic Diseases; Humans; Male; Middle Aged

Topics: Adult; Aged; Albuminuria; Allopurinol; Benzothiadiazines; Diuretics; Drug Hypersensitivity; Drug Interactions; Fever; Gastritis; Gastrointestinal Hemorrhage; Glomerulonephritis; Gout; Hematuria; Humans; Kidney; Male; Sodium Chloride Symporter Inhibitors

Topics: Aged; Allopurinol; Blood Cell Count; Dehydration; Erythrocytes; Fever; Hemoglobins; Hemorrhage; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lymphocytes; Male; Monocytes; Pharyngitis; Prednisone; Reticulocytes

Topics: Adolescent; Adult; Aged; Allopurinol; Anaphylaxis; Asparaginase; Blood Coagulation Disorders; Cytarabine; Daunorubicin; Drug Hypersensitivity; Female; Fever; Gastrointestinal Hemorrhage; Hallucinations; Humans; Hyperglycemia; Injections, Intravenous; Jaundice; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Liver; Male; Mercaptopurine; Methotrexate; Middle Aged; Oral Hemorrhage; Prednisone; Thioguanine; Uremia; Vincristine; Vomiting