SHM Converge Scientific Abstract ePoster Gallery-"Dress-Ing the Issue: Diagnosing a Drug Reaction to Allopurinol"

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This case describes a 37-year-old Thai man with gout who developed a progressively worsening diffuse pruritic rash, facial swelling, and systemic symptoms 1–2 months after starting allopurinol. The rash spread from his hands to his arms, trunk, legs, palms, soles, and face, and he also had fevers and chills. Because DRESS syndrome often presents late and with broad, nonspecific findings, diagnosis can be delayed.<br /><br />The patient was evaluated at a community hospital and then transferred for dermatology assessment. Infectious causes were investigated but were unlikely, and empiric antibiotics were stopped. Dermatology initially recommended topical steroids and an oral prednisone taper. However, his liver enzymes and creatinine continued to rise, prompting escalation to IV methylprednisolone 500 mg daily for 3 days. After this, his rash, pruritus, kidney function, and liver function improved. HLA-B*5801 testing was positive, supporting allopurinol as the trigger.<br /><br />The presentation was consistent with DRESS syndrome, a serious drug reaction characterized by fever, rash, eosinophilia, lab abnormalities, and internal organ involvement, often appearing 2–8 weeks after drug exposure. Common triggers include allopurinol, anticonvulsants, and certain antibiotics. Mortality is about 10%. HLA-B*5801 is especially important to check before starting allopurinol in Thai, Korean, and Han Chinese patients.<br /><br />Key teaching points: always consider DRESS in patients with diffuse rash plus laboratory abnormalities; obtain a careful medication history; use the RegiSCAR criteria to support diagnosis; and treat by stopping the offending drug and giving systemic corticosteroids.

Asset Subtitle

Darin Poei

Meta Tag

Author List Chanidapa Klinhom, Darin Poei, Evan J. Chen, Kevin S. Wei, Mollee Chu, Sarah Wang, Vivian H. LeTran

Category Clinical Vignettes

Concept Drug Reaction with Eosinophilia and Systemic Symptoms

Concept Withdrawal

Concept Drug Reaction

Concept Organ Involvement

Concept Allopurinol

Distinguished Non-Finalist

Presenter Organization USC/Los Angeles General Medical Center

Presenting Author Darin Poei

Track Adult

Keywords

DRESS syndrome

allopurinol

drug reaction

pruritic rash

facial swelling

eosinophilia

systemic corticosteroids

HLA-B*5801

RegiSCAR criteria

gout

Drug Reaction with Eosinophilia and Systemic Symptoms

Withdrawal

Drug Reaction

Organ Involvement

Allopurinol