DRESS syndrome associated with allopurinol

Abstract

Introduction: DrEss syndrome (Drug rash with Eosinophilia and systemic symptoms) is a severe drug reaction with an estimated mortality of up to 10% largely due to multi-organ dysfunction. Diagnosis is challenging because the extent of skin involvement does not always correlate with the extent of internal organ involvement and therefore early recognition of symptoms is vital to minimize morbidity and mortality. Management involves prompt cessation of the culprit drug, administration of corticosteroids and supportive treatment. case report: We report a case of an 87-year-old female with medical history significant for stage five chronic kidney disease, recently started on allopurinol for gout presented with dizziness, skin rash and eosinophilia which rapidly progressed to shock state followed by altered mentation, worsening renal failure, severe metabolic acidosis, deranged liver enzymes and gastrointestinal bleed requiring blood transfusion. conclusion: Allopurinol is commonly used in clinical practice for the treatment of symptomatic hyperuricemia and gout. It has been associated with DrEss syndrome especially when used indiscriminately.