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Allopurinol hypersensitivity — SCE Rheumatology MCQ

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HardCrystal ArthropathiesAllopurinol hypersensitivitySCE Rheumatology

A 53-year-old woman develops fever, facial oedema, rash, eosinophilia and acute kidney injury three weeks after starting allopurinol. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Stop allopurinol and arrange urgent specialist care

Stop allopurinol and arrange urgent specialist care is the single best answer because rash with eosinophilia and renal injury after allopurinol suggests severe hypersensitivity. The stem is testing management choice, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Septic arthritis is less suitable because it fits a different clinical pattern or a different treatment threshold; Reactive arthritis, Serum urate alone and Allopurinol during severe drug rash do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG219; BSR gout and hot swollen joint guidance; BNF