Allopurinol DRESS Syndrome — ESENeph MCQ

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ModerateAcute Kidney InjuryAllopurinol DRESS SyndromeESENeph

A 30-year-old man presents with acute kidney injury, eosinophilia, and a maculopapular rash 2 weeks after starting Allopurinol for gout. Liver enzymes are elevated. What serious drug reaction has occurred?

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Correct answer: A — Allopurinol hypersensitivity syndrome (DRESS syndrome)

Allopurinol hypersensitivity syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms – DRESS) is a severe, potentially fatal adverse drug reaction. It presents with skin rash, fever, eosinophilia, and organ involvement (hepatitis, AKI from acute interstitial nephritis). Risk factors include CKD (impaired oxypurinol clearance), HLA-B*5801 positivity (particularly in Southeast Asian and African-American populations), high starting dose, and concurrent diuretic use. Treatment involves immediate Allopurinol cessation and supportive care including glucocorticoids for severe cases.

Reference: BNF 2024 – Allopurinol; NICE CG169 2022 – Gout; Stamp et al 2016