Year: 2024
Type: article
Study design: Case Report
Abstract: Acute immunoallergic hepatitis presents as acute liver injury, often accompanied by nonspecific findings of fever, rash, and abdominal pain, and is often induced by drug ingestion.Allopurinol has been implicated in multiple cases of acute immunoallergic hepatitis.We present the case of a young East Asian male with gout who experienced acute immunoallergic hepatitis, complicated by DRESS syndrome with a severe cutaneous reaction, as a result of allopurinol intake.The patient was positive for the HLA-B58*01 gene, a significant risk factor for developing allopurinol-induced liver injury.The patient's liver injury and skin reaction improved with the administration of IV methylprednisolone, followed by a course of oral prednisone.Our case prompts clinicians to prescribe allopurinol with caution in certain high-risk populations and emphasizes the importance of administering corticosteroids early in such a presentation to avoid long-term liver damage.Keywords: Drug-induced liver injury; liver biopsy; liver function tests.of patients, which typically resolve spontaneously.[3] Rarely, allopurinol may induce more severe immunoallergic hepatitis that is often linked with drug reaction with eosinophilia and systemic symptoms (DRESS).Indeed, in one study of DILI, 67% of all allopurinol-induced DILI cases were associated with DRESS.[12] DRESS can have up to a 10% mortality rate, regardless of the culprit drug.[13] Therefore, identifying patients with this DILI-DRESS phenotype promptly upon admission, discontinuing the offending medication, and initiating steroid management are imperative to achieve good outcomes. Case ReportA 21-year-old Vietnamese male with no significant past medical history developed a gout flare and was started on colchicine and allopurinol as an outpatient.This patient had no prior history of liver disease, no IV drug use history, and no history of alcohol consumption.He completed a 3-day course of colchicine, and his gout flare resolved.He continued taking allopurinol 100 mg daily.After six weeks of allopurinol therapy, he noticed reddening of his skin, which worsened over the course of one week to a desquamating diffuse rash involving the face, back, arms, and hands (Fig. 1).He soon developed fevers and tachycardia as well as the acute edematous macular rash, and he presented to the emergency room for evaluation.
Author: Carolyn Brooks
Institution: Emory University
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W4404963968