Clin Mol Hepatol.  2014 Mar;20(1):71-75. 10.3350/cmh.2014.20.1.71.

Allopurinol-induced DRESS syndrome mimicking biliary obstruction

• Choi HG
• Byun J
• Moon CH
• Yoon JH
• Yang KY
• Park SC
• Han CJ

• KMID: 1737601
• DOI: http://doi.org/10.3350/cmh.2014.20.1.71

Abstract

An 84-year-old man was admitted to our hospital with fever, jaundice, and itching. He had been diagnosed previously with chronic renal failure and diabetes, and had been taking allopurinol medication for 2 months. A physical examination revealed that he had a fever (38.8degrees C), jaundice, and a generalized maculopapular rash. Azotemia, eosinophilia, atypical lymphocytosis, elevation of liver enzymes, and hyperbilirubinemia were detected by blood analysis. Magnetic resonance cholangiography revealed multiple cysts similar to choledochal cysts in the liver along the biliary tree. Obstructive jaundice was suspected clinically, and so an endoscopic ultrasound examination was performed, which ruled out a diagnosis of obstructive jaundice. The patient was diagnosed with DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) syndrome due to allopurinol. Allopurinol treatment was stopped and steroid treatment was started. The patient died from cardiac arrest on day 15 following admission.

Keyword

DRESS syndrome; Allopurinol; Jaundice

MeSH Terms

Aged, 80 and over
Allopurinol/adverse effects
Biliary Tract/pathology
Biliary Tract Diseases/diagnosis
Bilirubin/blood
Creatine/blood
Drug Hypersensitivity Syndrome/*diagnosis/etiology
Endosonography
Eosinophils/cytology
Humans
Magnetic Resonance Angiography
Male
Tomography, X-Ray Computed
Allopurinol
Bilirubin
Creatine