Clinical communication to the Editor

The Janus Faces of Allopurinol—Allopurinol Hypersensitivity Syndrome

Case Report

A 69-year-old white woman suffering from a complete metabolic syndrome was admitted for treatment of a decompensated arterial hypertension. The creatinine clearance was impaired (44.4 mL/min) with slight increases in serum creatinine (120 μmol/L, 1.3 mg/dL). The patient received thiazide diuretics.

Because of constantly raised values for serum uric acid (>480 μmol/L, >8.0 mg/dL), the patient was administered 300 mg allopurinol daily for antihyperuricemic therapy. After 3 months the patient

Discussion

To date, only a few cases of a syndrome characterized by exfoliative dermatitis with blood eosinophilia complicated by hepatitis and interstitial nephritis due to allopurinol therapy have been described in the literature. The clinical diagnosis of the allopurinol hypersensitivity syndrome is challenging because it usually starts delayed (eg, weeks or months) with various cutaneous manifestations, together with fever and fatigue (Table).¹ Extensive itching develops as a prodrome mostly after 4-6