Drug reaction with eosinophilia and systemic symptoms resulting from allopurinol

Abstract

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe drug reaction to the skin that is characterized by fever, lymphadenopathy, hematological abnormalities, involvement of internal organs, and reactivation of the virus. Allopurinol and other drugs are only a few of the medications that have been linked to DRESS. A Male, 42 years old, referred from a regional hospital, with complaints of reddish rash all over the body since 5 days. Physical examination revealed elevated body temperature. dermatologic status appeared to be obvious macules and erythematous patches with fuzzy boundaries, a variety of shapes, a large number, guttate to plaque size, confluent arrangement, and universal distribution in the facial, thorax, upper and lower extremities regions. This complaint arose after the patient took a high dose of allopurinol. Blood laboratory examination revealed eosinophilia, leukocytosis, elevated liver enzymes, and hypoalbuminemia. After treatment with steroid injections and topical creams and discontinuation of previous medications, there was clinical improvement. DRESS is a severe multiorgan hypersensitivity reaction that is mostly caused by a limited number of drugs in patients with a genetic predisposition. Accumulation of oxypurinol, especially in patients with decreased renal clearance, increases the risk of developing DRESS syndrome.