Department of Medicine III, University Clinics of Halle (Saale), Halle (Saale), Germany.
Am J Case Rep. 2021 Oct 11;22:e932921. doi: 10.12659/AJCR.932921.
BACKGROUND Allopurinol is the first-line therapy for the treatment of symptomatic hyperuricemia (gout). In clinical practice, there is a tendency to overmedicate asymptomatic patients who have elevated serum urate. Because of this practice, serious and life-threatening reactions such as Stevens-Johnson syndrome (SJS) or the more dramatic toxic epidermal necrolysis (TEN), both frequently caused by uricostatics, may occur. To increase awareness of these complications, we present a case with fulminant TEN caused by allopurinol. CASE REPORT A 75-year-old woman noticed a mildly itching skin rash accompanied by fever, shivering, and weakness approximately 3 weeks after taking newly prescribed allopurinol. The initial clinical examination revealed a generalized maculopapular exanthema. An adverse drug reaction was recognized, and allopurinol was discontinued. Ambulatory supportive therapy using prednisolone and cetirizine was started but failed. The patient developed a progressive exanthema with painful widespread blistering, skin peeling, and mucosal and conjunctival lesions. After recurrent presentations to the Emergency Department, the patient was transferred to our Intensive Care Unit (ICU). The clinical picture confirmed the suspected diagnosis of TEN. Massive fluid replacement, prednisolone, and cyclosporine were used as anti-inflammatory therapy. Polyhexanide and octenidine were applied for local treatment. All treatment measures were guided daily by a multidisciplinary team. After 7 days in the ICU, the patient was transferred to the Dermatology Department and was discharged from the hospital 42 days later. CONCLUSIONS With the prescription of allopurinol, there should be awareness of potentially life-threatening complications such as SJS or TEN. Patients with SJS or TEN should be immediately transferred to an ICU with dermatological expertise and multidisciplinary therapy.
别嘌醇是治疗症状性高尿酸血症（痛风）的一线药物。在临床实践中，有一种倾向是过度治疗血清尿酸升高的无症状患者。由于这种做法，可能会出现严重的危及生命的反应，如史蒂文斯-约翰逊综合征（SJS）或更戏剧性的中毒性表皮坏死松解症（TEN），这两种反应都经常由尿酸盐引起。为了提高对这些并发症的认识，我们报告了一例别嘌醇引起的暴发性 TEN 病例。
一名 75 岁女性在服用新处方的别嘌醇约 3 周后，注意到皮肤轻度瘙痒伴有发热、寒战和虚弱。最初的临床检查显示全身性斑丘疹疹。认识到药物不良反应并停用别嘌醇。开始使用泼尼松龙和西替利嗪进行门诊支持治疗，但失败。患者出现进行性皮疹，伴有疼痛广泛水疱、皮肤剥落和黏膜及结膜病变。在急诊科反复就诊后，患者被转至我们的重症监护病房（ICU）。临床图片证实了疑似 TEN 的诊断。大量液体替代、泼尼松龙和环孢素用于抗炎治疗。聚己双胍和奥替尼啶用于局部治疗。所有治疗措施均由多学科团队每日指导。在 ICU 治疗 7 天后，患者转至皮肤科并在 42 天后出院。
在开具别嘌醇处方时，应意识到可能危及生命的并发症，如 SJS 或 TEN。SJS 或 TEN 患者应立即转至具有皮肤科专业知识和多学科治疗的 ICU。
