Taghvaye Masoumi H, Hadjibabaie M, Zarif-Yeganeh M, Arasteh O
Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Research Center for Rational Use of Drugs, and Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
J Clin Pharm Ther. 2017 Oct;42(5):642-645. doi: 10.1111/jcpt.12556. Epub 2017 May 29.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare and potentially life-threatening drug reaction. Allopurinol is one of the most frequently reported drugs accounting for DRESS syndrome development. In contrast to allopurinol, DRESS syndrome induced by teicoplanin has not been reported frequently.
A 50-year-old woman was admitted to receive FLAG chemotherapy regimen (fludarabine, cytarabine (high-dose Ara-C), granulocyte colony-stimulating factor) for relapsed acute lymphoblastic leukaemia (ALL) treatment. Allopurinol was initiated at a dose of 300 mg per day 48 hours before chemotherapy regimen initiation, for tumour lysis syndrome prophylaxis. Seven days after allopurinol initiation, the patient presented with fever, dyspnoea, shortening of breath, facial oedema, generalized pruritus, erythema and macular rash affecting the face, abdomen, trunk, upper and lower limbs and an elevation in hepatic enzymes. Allopurinol was immediately discontinued and intravenous hydrocortisone was started concomitantly alongside other supportive measures. About 72 hours later, pruritus, erythema and rash were ameliorated and abnormalities in liver tests were improved. Afterwards, teicoplanin administration led to severe deterioration of pruritus, erythema and rash; subsequently, serum alanine aminotransferase increased again and episodes of worsening dyspnea occurred. Signs of hypersensitivity reaction were reduced by discontinuation of teicoplanin and supportive care.
We report a case of allopurinol-induced DRESS syndrome, which was exacerbated by administration of teicoplanin. It can be suggested that the administration of drugs with high possibility of hypersensitivity reactions should be avoided during the acute phase of DRESS syndrome.
药物超敏反应伴嗜酸性粒细胞增多和全身症状（DRESS）综合征是一种罕见且可能危及生命的药物不良反应。别嘌醇是导致DRESS综合征最常报道的药物之一。与别嘌醇不同，替考拉宁引起的DRESS综合征报道较少。
一名50岁女性因复发性急性淋巴细胞白血病（ALL）接受FLAG化疗方案（氟达拉滨、阿糖胞苷（大剂量阿糖胞苷）、粒细胞集落刺激因子）治疗入院。在化疗方案开始前48小时开始服用别嘌醇，剂量为每日300毫克，以预防肿瘤溶解综合征。服用别嘌醇7天后，患者出现发热、呼吸困难、呼吸急促、面部水肿、全身瘙痒、红斑和斑丘疹，累及面部、腹部、躯干、上肢和下肢，同时肝酶升高。立即停用别嘌醇，并开始静脉注射氢化可的松及其他支持措施。约72小时后，瘙痒、红斑和皮疹有所改善，肝功能检查异常也有所改善。此后，使用替考拉宁导致瘙痒、红斑和皮疹严重恶化；随后，血清丙氨酸转氨酶再次升高，呼吸困难加重。停用替考拉宁并给予支持治疗后，过敏反应体征减轻。
我们报告一例别嘌醇引起的DRESS综合征，替考拉宁的使用使其加重。提示在DRESS综合征急性期应避免使用高敏反应可能性大的药物。
