allopurinol and Sarcoidosis

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

The widely accepted standard therapy for cutaneous sarcoidosis includes corticosteroids, antimalarials, and methotrexate. However, a better understanding of the basic immunopathogenic properties of sarcoidosis has elucidated a number of steps critical to the persistence and progression of disease that may be vulnerable to treatment by targeted therapy. This article reviews both standard and newer therapeutic options for cutaneous sarcoidosis.

Topics: Abnormalities, Drug-Induced; Adrenal Cortex Hormones; Allopurinol; Animals; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antigen Presentation; Antimalarials; Chlorambucil; Contraindications; Cyclosporine; Cytokines; Dermatologic Agents; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Infliximab; Isoxazoles; Laser Therapy; Leflunomide; Male; Melatonin; Methotrexate; Models, Immunological; Pentoxifylline; Pregnancy; Pregnancy Complications; Sarcoidosis; Skin Diseases; Tetracyclines; Th1 Cells; Thalidomide

Topics: Acidosis, Renal Tubular; Bacterial Infections; Citrates; Crystallization; Cystinuria; Diphosphates; Female; Gastrointestinal Diseases; Humans; Hypercalcemia; Hyperparathyroidism; Magnesium; Male; Metabolism, Inborn Errors; Mucoproteins; Oxalates; Quaternary Ammonium Compounds; Sarcoidosis; Solubility; Uric Acid; Urinary Calculi; Vitamin D; Xanthine Oxidase

Granulomatous reactions to tattoo ink have been frequently associated with exogenous pigment, although sometimes they are the manifestation of a cutaneous or an underlying systemic sarcoidosis. We report a case of a patient with a granulomatous reaction to a black tattoo pigment treated with 3% topical allopurinol for 3 months. We observed complete resolution without any side-effects. Examination and follow-up ruled out sarcoidosis. Oral allopurinol has been proven to be effective for the management of granulomatous reactions to tattoos. Based on the significant improvement we have described in our patient, we recommend new studies to reveal all the potential benefits of the topical use of allopurinol for the treatment of granulomatous reactions to tattoo ink.

Topics: Allopurinol; Humans; Ink; Sarcoidosis; Skin; Skin Diseases; Tattooing

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

Topics: Adult; Allopurinol; Female; Humans; Male; Middle Aged; Sarcoidosis; Skin Diseases

Topics: Adult; Allopurinol; Antimetabolites; Hand Dermatoses; Humans; Male; Sarcoidosis; Treatment Outcome

Topics: Adolescent; Allopurinol; Antimetabolites; Facial Dermatoses; Humans; Male; Sarcoidosis; Skin Diseases

Topics: Adult; Allopurinol; Antimetabolites; Diagnosis, Differential; Disease Progression; Humans; Male; Sarcoidosis; Skin; Skin Diseases

Several reports more than ten years ago provided evidence that allopurinol may be effective for cutaneous sarcoidosis. We therefore treated two patients with histologically confirmed scar sarcoidosis and two with nodular sarcoidosis. A daily dosage of 300 mg allopurinol was given over a period of 4-7 months as single drug therapy. In both patients with scar sarcoidosis, the skin manifestations completely regressed while in the patients with nodular sarcoidosis there was significant improvement. The concomittant pulmonary involvement in two patients was unpredictable, in one patient improved while the other was deteriorated, The mode of action is still unclear but because of the positive results and the low rate of side effects, allopurinol seems a reasonable agent for treating cutaneous sarcoidosis.

Topics: Administration, Oral; Adult; Aged; Allopurinol; Enzyme Inhibitors; Female; Free Radicals; Humans; Male; Middle Aged; Reactive Oxygen Species; Sarcoidosis; Skin; Skin Diseases

Topics: Allopurinol; Antimetabolites; Female; Granuloma Annulare; Humans; Middle Aged; Sarcoidosis; Skin Diseases

We report a 57-year-old woman, with progressive disseminated cutaneous sarcoidosis, whose eruption responded to treatment with allopurinol.

Topics: Allopurinol; Dermatologic Agents; Female; Humans; Middle Aged; Sarcoidosis; Skin Diseases

Scar sarcoidosis is one of the rare cutaneous manifestations of sarcoidosis. Apart from the clinical picture, suppression of the cell-mediated immunity can often be determined when tuberculin tests and testing for recall antigens are carried out. In the present case of a 68-year-old woman patient scar sarcoidosis and pulmonary sarcoidosis were detected. Remarkably, a strongly positive tuberculin reaction was found, while acute tuberculosis and former BCG vaccination were excluded. Both references in the literature and the case presented demonstrate that a positive tuberculin test, while very unusual in sarcoidosis, does not however, preclude the diagnosis. On the basis of some case reports in the literature, our patient was treated with allopurinol; impressive improvement of both the skin and the pulmonary manifestations was noted. Despite the well-known phenomenon of spontaneous regression in sarcoidosis, we recommend a clinical trial with allopurinol as this substance is well tolerated.

Topics: Allopurinol; Cicatrix; Diagnosis, Differential; Facial Dermatoses; Female; Humans; Immune Tolerance; Middle Aged; Sarcoidosis; Sarcoidosis, Pulmonary; Skin; Tuberculin Test

We describe a patient who initially formed calcium-containing renal stones owing to gouty diathesis and hypocitraturia. On therapy with 300 mg. allopurinol and 60 mEq. potassium citrate daily serum uric acid decreased from 9.2 to 5.8 mg. per dl., urinary pH increased from less than 5.5 to 6.6 and urinary citrate increased from 223 to 1,005 mg. per day. Four months later while still on this medical regimen, the patient presented with hypercalcemia (13.4 mg. per dl.), high serum 1,25-dihydroxyvitamin D (65 pg. per ml.) and hypercalciuria (598 mg. per day), which subsequently were found to result from sarcoidosis. Prednisone therapy normalized the disturbances in calcium metabolism. During 33 months of combined treatment with 7.5 to 10 mg. prednisone a day, allopurinol and potassium citrate, the patient was free of stones and he had normal urinary calcium, pH and citrate. However, a calcium stone formed 1 month after discontinuation of prednisone therapy, although treatment with allopurinol and potassium citrate was continued. The patient had marked hypercalciuria of 447 to 465 mg. per day, despite normal urinary pH, citrate and uric acid. This case represents calcium stone formation in a patient with 2 separate etiologies for stone disease, that is gouty diathesis and sarcoidosis. Therapeutic regimens directed at the correction of both metabolic disturbances were required to control renal stone formation.

Topics: Allopurinol; Calcium Oxalate; Citrates; Citric Acid; Disease Susceptibility; Gout; Humans; Kidney Calculi; Male; Middle Aged; Prednisone; Recurrence; Sarcoidosis

Topics: Adult; Allopurinol; Female; Humans; Male; Sarcoidosis; Skin Diseases

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: Adult; Allopurinol; Humans; Male; Middle Aged; Sarcoidosis; Skin Diseases