allopurinol and Scarlet-Fever

A 41 year old patient started treatment with 300 mg/d allopurinol for asymptomatic hyperuricaemia (9,2 mg/dl).. 4 weeks later he developed exfoliative skin lesions with haemorrhage, fever, eosinophilia and acute liver and renal failure, typical for an allopurinol hypersensitivity syndrome (AHS).An orthotopic liver-transplantation was performed.. The AHS is a serious iatrogenic disease. 2 % of the treated patients develop a skin rash. 0,4 % of these patients experience suddenly and unforeseen a severe hypersensitivity with a mortality of 14-30 %. An early diagnosis is often very difficult. In the pathogenesis different causes are discussed. A hereditary component is involved. Of essential importance is the amount of the starting dose, the kidney function and concomitant drugs. In an asymptomatic hyperuricaemia the application of allopurinol is not indicated. If strong indications are present, the allopurinol therapy has to start with the lowest dose (100 mg/d). If required this dose should be increased under consequent supervision only.

Topics: Adult; Allopurinol; Amoxicillin; Chemical and Drug Induced Liver Injury; Dose-Response Relationship, Drug; Drug Hypersensitivity; Drug Interactions; Drug Therapy, Combination; Follow-Up Studies; Humans; Hyperuricemia; Kidney Failure, Chronic; Liver Transplantation; Male; Risk Factors; Scarlet Fever; Stevens-Johnson Syndrome