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Allopurinol-associated DRESS syndrome — SCE Acute Medicine MCQ

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HardAcute Rheumatological/Dermatological EmergenciesAllopurinol-associated DRESS syndromeSCE Acute Medicine

Six weeks after starting allopurinol, a patient develops fever, facial oedema, widespread rash, eosinophilia, hepatitis and acute kidney injury without epidermal detachment. What is the priority?

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Correct answer: C — Give oral antibiotics and urgent source control

The best answer is “Give oral antibiotics and urgent source control”. This is correct because delayed rash, facial oedema, eosinophilia and multi-organ injury are characteristic of drug reaction with eosinophilia and systemic symptoms. Withdrawal is essential and systemic corticosteroid may be needed for severe organ disease with specialist input. Rechallenge can provoke a faster, more severe reaction.

Reference: MHRA allopurinol severe-cutaneous-reaction safety update: https://www.gov.uk/drug-safety-update/medsafetyweek-november-2024-your-yellow-card-report-helps-prevent-future-harm-to-others-and-improves-patient-safety