Abstract
Adverse reactions to allopurinol frequently involve the skin, liver, kidneys, gastrointestinal system and bone marrow. Pharmacologic studies have suggested that the serum concentration of oxipurinol appear to correlate with the development of life-threatening allopurinol toxicity. A male patient (89-years-old) with asyiiiptomatic hyperuricemia (8.1 mg/dl) was treated with allopurinol (300 mg/24 h). No concommitant medications were administered. Six weeks later he presented fever (39°C), eosinophilia (1.92×109/L), exfoliative dermatitis, hepatocellular injury and renal failure (serum creatinine, 4.6 mg/dl). A plasma sample drawn 8 hours after the patient's last dose of allopurinol showed an oxipurinol concentration by HPLC of 50 μM. This drug was discontinued and prednisone was instituted. His symptoms and epidermal necrolysis cleared and liver and renal abnormalities subsided over 2 weeks (serum creatinine, 2.0 mg/dl). Plasma oxipurinol levels in 4 patients with uric acid overproduction (3 with HPRT deficiency and 1 with PRPPs overactivity) who were receiving allopurinol (5-10 mg/Kg/24 h) ranged from 48 to 175 μM. No adverse reactions were documented in these patients. This case illustrates that serious hypersensitivity reactions to allopurinol may occur despite plasma oxipurinol concentrations within what it is considered a normal therapeutic level (<100 μM).
Article PDF
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Casas, E., Puig, J., Mateos, F. et al. 120 THE ALLOPURINOL HYPERSENSITIVITY SYNDROME: ITS RELATION TO PLASMA OXIPURINOL LEVELS. Pediatr Res 24, 131 (1988). https://doi.org/10.1203/00006450-198807000-00144
Issue Date:
DOI: https://doi.org/10.1203/00006450-198807000-00144