allopurinol and Lymphatic-Diseases

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

Acute tumor lysis syndrome developed in a 30-year-old man with non-Hodgkin lymphoma after dexamethasone administration. To the best of our knowledge, this case is the first one reported following single agent corticosteroid treatment.

Topics: Adult; Allopurinol; Bicarbonates; Combined Modality Therapy; Dexamethasone; Epidural Space; Humans; Lymphatic Diseases; Lymphoma, Non-Hodgkin; Male; Sodium; Sodium Bicarbonate; Spinal Cord Compression; Spinal Cord Neoplasms; Tumor Lysis Syndrome

Immunoblastic lymphadenopathy is a recently described lymphoproliferative disorder, presumably of B-cell origin. It is characterized by regional or generalized lymphadenopathy, usually associated with hypergammaglobulinemia or dysproteinemia. Other findings may be hepatosplenomegaly, dermatitis, fever, malaise, weight loss, and various altered immunologic reactions. Histologically, the involved lymph nodes show immunoblast, plasmacytoid, and plasma cell proliferation. This may be extranodal as well. The case reported here is one of the few followed up prospectively. The patient's purpuric eruption was an apparent manifestation of a type II mixed cryoglobulinemia. Differing from what has usually been reported, we noted hypogammaglobulinemia and findings in part of altered cell-mediated immunity. Despite leukopenia and anemia there were no infectious episodes. Although a satisfactory treatment regimen has not been established, there was beneficial response to prednisone and short courses of melphalan.

Topics: Allopurinol; Anemia; B-Lymphocytes; Cryoglobulins; Female; Humans; Leukopenia; Lymphatic Diseases; Melphalan; Middle Aged; Paraproteinemias; Prednisone; Purpura, Hyperglobulinemic

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