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DRESS Syndrome Allopurinol — SCE Infectious Diseases MCQ

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ModerateAntimicrobial StewardshipDRESS Syndrome AllopurinolSCE Infectious Diseases

A 55-year-old man with recently diagnosed gout is started on Allopurinol. Three weeks later, he develops fever, widespread maculopapular rash with facial oedema, eosinophilia (2.5 × 10⁹/L), and elevated transaminases (ALT 280 U/L). What is the diagnosis?

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Correct answer: D — Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) secondary to Allopurinol — this is a medical emergency

DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) presents 2–8 weeks after drug initiation with fever, rash (often facial oedema), eosinophilia (>1.5 × 10⁹/L or >10%), and internal organ involvement (liver — most common; kidney, lung, heart). Allopurinol is one of the most common causes (risk increased with HLA-B*5801 — prevalent in South-East Asian and African populations). Management: immediate drug discontinuation, supportive care, systemic corticosteroids for severe cases. Mortality is 5–10%. HLA-B*5801 testing is recommended before starting Allopurinol in high-risk ethnic groups.

Reference: BAD 2023 – DRESS; MHRA 2024 – Allopurinol; BSR 2017 – Gout