allopurinol and Granuloma

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

To review the current concepts in toxic and drug-induced granulomatous reactions.. Granulomatous reactions are induced by various chemical agents, treatments or foreign bodies. According to the breaking way into the organism, the lungs, the liver, the kidneys or the skin are mainly concerned, but systemic granulomatosis mimicking sarcoidosis is possible. Therefore systematic analysis of environmental, occupational and leisure exposures and quest for medical or illicit drugs is mandatory to identify the responsible agent. Over the recent period, chronic beryllium disease, interferon-alpha therapy, BCG immunotherapy and allopurinol have been more frequently involved.. Literature review uncovers a variety of potential toxic exposures and highlights the necessity of a clear sighted research to identify them.

Topics: Allopurinol; Antimetabolites; BCG Vaccine; Berylliosis; Chemical and Drug Induced Liver Injury; Granuloma; Humans; Immunologic Factors; Interferon-alpha; Kidney Diseases; Lung Diseases; Sarcoidosis; Skin Diseases

Allopurinol is a drug of wide clinical use and good tolerance. Some patients develop severe hypersensitivity due to immunologic reaction to the drug. A new case which fulfills all the diagnostic criteria of the syndrome of allopurinol hypersensitivity with associated clinical manifestations of multiple mononeuritis and evidence of granulomas and vasculitis in liver biopsy as the most significant data is reported. The syndrome was favorably resolved following withdrawal of the drug without need for corticoid therapy. The characteristics of the cases described in the Spanish literature over the last few years are globally reviewed. The absence of mortality is of note. The inconvenience of prescribing allopurinol to patients with asymptomatic hyperuricemia is emphasized.

Topics: Aged; Allopurinol; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Granuloma; Humans; Liver Diseases; Male; Neuritis; Spain; Syndrome; Vasculitis

Topics: Allopurinol; Chemical and Drug Induced Liver Injury; Cholestasis; Chronic Disease; Female; Granuloma; Hepatitis; Humans; Indoles; Liver Cirrhosis; Methyldopa; Nitrofurantoin; Oxyphenisatin Acetate; Phenylbutazone

A 5-year-old castrated male Domestic Shorthair cat presented for evaluation of chronic history of nasal discharge and nasal stridor. On computed tomography (CT), a destructive ill-defined mass of soft tissue attenuation was occupying the right nasal cavity and extending into the left nasal cavity, nasopharynx, and rostral cranial cavity. Histopathology of the rhinoscopically excised samples consisted with destructive granulomatous rhinitis secondary to Leishmania spp. Chronic granulomatous rhinitis with intracranial and nasopharyneal extension secondary to Leishmania spp. infection should be included as a differential diagnosis for a destructive nasal mass of soft tissue attenuation, especially in endemic regions for leishmaniasis.

Topics: Allopurinol; Animals; Antiprotozoal Agents; Cat Diseases; Cats; Diagnosis, Differential; Granuloma; Leishmaniasis; Male; Rhinitis; Tomography, X-Ray Computed

Granulomatous reactions to tattoo ink are most commonly associated with mercury sulfide, a component of red pigments. Treatment options show limited results. Allopurinol, an inhibitor of xanthine oxidase, has been reported as a successful alternative treatment to granulomatous disorders, such as sarcoidosis and granulomatous reactions to fillers and tattoos. We report a case of granulomatous reaction to red tattoo pigment treated with allopurinol for 6 months. Good clinical improvement could be noticed during this time. Two months after we stopped the treatment, the lesion recurred. Allopurinol emerges as an important drug for the management of granulomatous reactions caused by tattoo pigments. Based on the significant clinical improvement noticed during its use, we recommend new studies to elucidate all the potential benefits of the use of allopurinol for the treatment of granulomatous reactions to tattoo ink.

Topics: Allopurinol; Coloring Agents; Edema; Enzyme Inhibitors; Female; Granuloma; Humans; Recurrence; Tattooing; Xanthine Oxidase; Young Adult

Topics: Allopurinol; Diagnosis, Differential; Drug Eruptions; Drug Hypersensitivity Syndrome; Gout Suppressants; Granuloma; Humans; Male; Middle Aged

We describe a 64-year-old man with past chronic myeloid leukemia. Palisading neutrophilic granulomatous dermatitis of the hands was diagnosed and related to recent allopurinol intake. Allopurinol is known to rarely cause granulomatous reactions, but this appears to be the first case of palisading neutrophilic granulomatous dermatitis induction. Possible mechanisms include immune complex deposition, an immune response directed against the metabolites of allopurinol, or allopurinol hypersensitivity exclusively localized to the skin.

Topics: Allopurinol; Drug Eruptions; Gout Suppressants; Granuloma; Hand; Humans; Male; Middle Aged; Neutrophil Infiltration

We describe a 66-year-old woman hospitalized with fever, fatigue and hepatopathy. In her medical history arterial hypertension (treated with propranolol and lisinopril), diabetes mellitus type 2 (no treatment before admission) and a gout arthropathy were noted wherefore a therapy with allopurinol 300 mg per day has been started 4 months before. Liver biopsy revealed fibrin-ring granulomas, compatible with allopurinol-induced hepatitis. Because of persistence of high fever after stopping allopurinol, steroids (1 mg/kg) were started. Under this treatment, she developed pancytopenia and fever. The bone marrow aspiration revealed Leishmania infantum. A second liver biopsy showed amastigotes and a disappearance of the granulomas. The history revealed a travel to Malta 2 years earlier. Despite adequate treatment with liposomal amphotericin B the patient deteriorated and finally died in septic shock.

Topics: Aged; Allopurinol; Animals; Biopsy; Bone Marrow; Chemical and Drug Induced Liver Injury; Fatal Outcome; Female; Fibrin; Gout Suppressants; Granuloma; Humans; Leishmania infantum; Leishmaniasis, Visceral; Liver

Allopurinol-induced hypersensitivity syndrome is characterized by an idiosyncratic reaction involving multiple-organs, which usually begins 2 to 6 weeks after starting allopurinol. In rare cases, the adverse reactions to allopurinol are accompanied by a variety of liver injury, such as reactive hepatitis, granulomatous hepatitis, vanishing bile duct syndrome, or fulminant hepatic failure. Here we report a case with granulomatous hepatitis and ductopenia. A 69-year-old man with chronic renal failure, hyperuricemia, and previously normal liver function presented with jaundice, skin rash, and fever 2 weeks after taking allopurinol (200 mg/day). In histopathology, a liver biopsy specimen showed mild spotty necrosis of hepatocytes, marked cholestasis in parenchyma, and some granulomas in the portal area. There were vacuolar degeneration in the interlobular bile ducts and ductopenia in the portal tracts. Pathologic criteria strongly suggested the presence of allopurinol-induced granulomatous hepatitis with ductopenia and cholestasis. The patient fully recovered following the early administration of systemic corticosteroid therapy.

Topics: Aged; Allopurinol; Antimetabolites; Bile Duct Diseases; Bile Ducts, Intrahepatic; Chemical and Drug Induced Liver Injury; Cholestasis; Drug Eruptions; Granuloma; Humans; Kidney Failure, Chronic; Male

Although drug induced interstitial nephritis is a relatively common cause of renal failure,granulomatous forms remain a rare condition. The development of a chronic granulomatous interstitial nephritis due to allopurinol is exceptional, only three cases have been described previously. We report on a patient who presented a granulomatous interstitial nephritis after 10 years of allopurinol administration (300 mg/day). At diagnosis, he had end stage renal disease and dialysis treatment was needed. Two months after drug withdrawal and on corticoid treatment a slow recovery of renal function was observed, allowing the interruption of dialysis. Two years after, the creatinine clearance is 23 ml/min,being dialysis free. We discuss the differential diagnosis of granulomatous interstitial nephritis and its rare association with allopurinol treatment.

Topics: Adrenal Cortex Hormones; Aged; Allopurinol; Chronic Disease; Creatinine; Diagnosis, Differential; Granuloma; Humans; Hyperuricemia; Kidney Failure, Chronic; Male; Nephritis, Interstitial; Renal Dialysis; Sarcoidosis

Granulomatous inflammation in a tissue specimen raises concern about infection with Mycobacterium tuberculosis, atypical mycobacteria, certain fungi, Brucella species, and other infectious agents. Inflammatory disorders, such as sarcoidosis, crystal-associated arthritis, or foreign body reactions also are considered when granulomatous changes are seen on histological examination of a tissue specimen. We describe two cases of granulomatous tenosynovitis due to tophaceous deposits in patients with gout. In one case, tuberculous synovitis was considered the primary diagnosis until the diagnosis of gout was confirmed by examination of a tissue specimen with polarized light. In the second case, gout and tuberculosis were found in the patient's wrist joint. After antituberculous therapy was discontinued, he continued to have wrist synovitis and chronic drainage due to granulomatous tophaceous gout. The findings in this report suggest that gouty tenosynovitis can mimic tuberculous tenosynovitis and that gout should be considered in the differential diagnosis of granulomatous tenosynovitis, especially when acid-fast stains and cultures are negative for mycobacteria.

Topics: Adult; Allopurinol; Antitubercular Agents; Diagnosis, Differential; Finger Joint; Gout; Gout Suppressants; Granuloma; Humans; Male; Middle Aged; Synovitis; Tendons; Tenosynovitis; Tuberculosis, Osteoarticular; Wrist Joint

Topics: Allopurinol; Female; Granuloma; Humans; Kidney; Middle Aged; Nephritis, Interstitial; Uric Acid

To test the hypothesis that allopurinol-associated granulomatous hepatitis may present itself with fibrin-ring granulomas, we requested details of such cases, as reported to the World Health Organization, from 13 national adverse reaction monitoring centers, and as reported in the literature. Details and histology of 6 cases were obtained and reviewed. All consisted of acute hypersensitivity signs with fever, rash, arthralgia, or eosinophilia as hallmarks, starting within 6 wk of commencing treatment with allopurinol. In all cases there were either epithelioid granulomas or granulomalike lesions, but none of these contained fibrin rings. It is concluded that, if fibrin-ring granulomas are a manifestation of allopurinol-induced granulomatous hepatitis, this feature is probably uncommon.

Topics: Adult; Aged; Allopurinol; Chemical and Drug Induced Liver Injury; Female; Fibrin; Granuloma; Humans; Male

Topics: Allopurinol; Granuloma; Humans; Male; Middle Aged; Nephritis, Interstitial

Acute granulomatous interstitial nephritis and acute granulomatous hepatitis were simultaneously observed in the same patient. Clinical and anamnestic arguments suggest that allopurinol could be responsible for this double localization, but a possible part played by furosemide cannot be excluded. The patient spontaneously recovered without corticosteroid therapy. Such an acute drug induced association did not have been proved so far.

Topics: Acute Disease; Allopurinol; Atenolol; Biopsy; Chemical and Drug Induced Liver Injury; Female; Furosemide; Granuloma; Humans; Middle Aged; Nephritis, Interstitial

Hepatic fibrin-ring granulomas were found in a 35-yr-old man who developed fever, myalgias, rash, eosinophilia, and abnormal liver function tests 4 wk after the beginning of allopurinol treatment. All clinical and biochemical abnormalities spontaneously resolved within 6 wk after cessation of therapy. There was no evidence for Q fever or Hodgkin's disease, which are the recognized causes of hepatic fibrin-ring granulomas. It is suggested that allopurinol hypersensitivity might be an additional cause of these peculiar granulomas.

Topics: Adult; Allopurinol; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Fibrin; Granuloma; Humans; Liver; Liver Diseases; Male

The objectives of this study were to describe the ultrastructure of granulocyte-Schistosoma mansoni egg interaction and to determine the role of reduced oxygen products as effectors of cell-mediated damage to the parasite target. Granulocytes attached to the parasites and closely applied their plasma membranes to the microspicules of the egg shell 30 min after mixing in the presence of immune serum. By 4 h, the egg shell was fractured and granulocyte pseudopodia extended toward the underlying miracidium. Granulocyte attachment to eggs resulted in release of O2- (0.30-0.52 nmol/min per 2 X 10(6) cells) and accumulation of H2O2 (0.14-0.15 nmol/min) in the presence of antibody or complement. Granulocytes reduced egg tricarboxylic-acid cycle activity and hatching by 28.3 +/- 0.9 and 35.2 +/- 2.8%, respectively (cell-egg ratio of 1,000: 1). Exogenous superoxide dismutase (10 micrograms/ml) inhibited granulocyte toxicity for egg metabolic activity (3.0 +/- 2.1% reduction in acetate metabolism vs. 28.3 +/- 0.9% decrease in controls without superoxide dismutase, P less than 0.0005) and hatching (12.5 +/- 1.8% reduction, P less than 0.0005), whereas catalase and heparin had no effect. Inhibitors of myeloperoxidase (1 mM azide, cyanide, and methimazole) augmented granulocyte-mediated toxicity of egg tricarboxylic-acid cycle activity (44-58% reduction in activity vs. 31 and 35% reduction in controls), suggesting that H2O2 released from cells was degraded before reaching the target miracidium. Oxidants generated by acetaldehyde (2 mM)-xanthine oxidase (10 mU/ml) also decreased egg metabolic activity and hatching by 62.0 +/- 9.0 and 38.7 +/- 7.3%, respectively. Egg damage by the cell-free system was partially prevented by superoxide dismutase (26.5 +/- 4.2% reduction in egg tricarboxylic-acid activity) and completely blocked by catalase (0% reduction in activity). These data suggest that granulocyte-mediated toxicity for S. mansoni eggs is dependent on release of O2- or related molecules. These oxygen products, unlike H2O2, may readily reach the target miracidium where they may be converted to H2O2 or other microbicidal effector molecules.

Topics: Acetaldehyde; Animals; Catalase; Citric Acid Cycle; Female; Granuloma; Heparin; Humans; Hydrogen Peroxide; In Vitro Techniques; Mice; Neutrophils; Ovum; Oxygen; Schistosoma mansoni; Superoxide Dismutase; Superoxides; Xanthine Oxidase

Xanthine oxidase activity: NAD+-dependent form (D) and O2-dependent form (O) were carried out in cytosol supernatants of connective tissue growth (T.C.N.F.), skin tail, liver and plasma of carrageenan induced granuloma in the Rat. The specific activities of skin, liver and plasma were normal in animals with a granuloma. The total specific activity (D + O): 7.53 +/- 0.98 mU/mg protein, and the percentage of form O: 51.6 +/- 5.1 of the granulomatous tissue as compared to the tail are significantly increased. These results suggest the likely function of xanthine oxidase during the inflammatory response.

Topics: Animals; Carrageenan; Granuloma; Male; NAD; Oxygen; Rats; Rats, Inbred Strains; Xanthine Oxidase

Topics: Aged; Allopurinol; Chemical and Drug Induced Liver Injury; Female; Granuloma; Humans; Liver

A 36-year-old man had pain in both knees and an elevated uric acid concentration; his liver function was normal. Allopurinol therapy was started, 100 mg twice daily. After one month fever, lethargy, and severe polyarthralgia developed. On admission to our hospital liver function was abnormal, and a liver biopsy specimen showed granulomas with cholangitis and pericholangitis. He also had lymphopenia with a reduced number of T cells and granulomas in the bone marrow. One month after discontinuation of allopurinol therapy the patient was clinically well with normal liver function and a normal lymphocyte count. A repeated liver biopsy specimen showed normal liver tissue with no granulomas. The onset of the symptoms and findings shortly after the initiation of allopurinol therapy, and their disappearance after the discontinuation of therapy suggest a drug-induced hypersensitivity.

Topics: Allopurinol; Chemical and Drug Induced Liver Injury; Cholangitis; Granuloma; Humans; Liver Diseases; Male; Middle Aged; Sarcoidosis

Topics: Allopurinol; Biopsy; Chemical and Drug Induced Liver Injury; Female; Granuloma; Humans; Liver; Middle Aged; Uric Acid

A patient with malignant histiocytosis presented with a number of unusual features including fever, leukemoid reaction, and eosinophilia. Other confusing findings included lymph node biopsies which showed reactive changes, noncaseating granuloma, and atypical Reed-Sternberg cells. These features are compared with cases appearing in the literature. The course was rapidly progressive despite combination chemotherapy.

Topics: Adult; Allopurinol; Autopsy; Bone Marrow Examination; Cyclophosphamide; Eosinophilia; Ethambutol; Female; Granuloma; Humans; Isoniazid; Leukocytosis; Lymph Nodes; Lymphatic Diseases; Male; Prednisone; Streptomycin; Vincristine

Topics: Allopurinol; Bone and Bones; Connective Tissue; Gout; Granuloma; Humans; Remission, Spontaneous

Topics: Acute Kidney Injury; Alcoholism; Allopurinol; Chemical and Drug Induced Liver Injury; Granuloma; Humans; Liver; Liver Function Tests; Male; Middle Aged