Allopurinol induced severe cutaneous adverse reactions: Vigilance of prescription (31 cases)

Abstract

IntroductionAllopurinol is a hypouricemic drug that has been prescribed since 1963. It is one of the most common drugs that induce Severe Cutaneous Adverse Reactions (SCARs), namely Stevens Johnson syndrome (SJS)/Lyell syndrome (LS) and DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). In our hospital series, we report cases of SCARs attributed to allopurinol in order to sensitize prescribers to the risk of its misuse. Patients and methodsWe carried out a retrospective study from 2011 to 2021 of patients hospitalized at our dermatology department for SCARs induced by allopurinol. Imputability was confirmed by the French methodology of Bégaud et al. ResultsWe identified 31 cases. The median age was 63 years (26–83). The sex-ratio (M/F) was 0.34. Twenty-two point five percent of patients were being followed for chronic renal disease. Allopurinol was prescribed in 77.4% cases for laboratory indications of asymptomatic hyperuricemia. Combined use with a thiazide diuretic was found in 51.6% of patients. The clinical forms were: 21 DRESS syndrome, 5 LS, 2 overlap syndrome and 3 SJS. The median time to onset of clinical signs was 4 days to 5 weeks for SJS/LS and 2 to 8 weeks for DRESS. Complications were as follows: renal failure (48.3%), hepatic cytolysis (51.6%), electrolyte imbalance in (54.8%), severe sepsis (16.6%) and corneal ulcer (6.4%). Major hypereosinophilia was noted in 48.3% of cases and was significantly associated with hepatic cytolysis (P=0.014). Five patients required a stay in the intensive care unit, with death occurring in 12.9%. ConclusionDespite its capacity to cause life-threatening SCARs, allopurinol continues to be prescribed in most cases of asymptomatic hyperuricemia. Such misuse in terms of indication and follow-up warrants the raising of physicians’ awareness concerning the benefit/risk ratio.