Allopurinol-Induced Severe Hypersensitivity with Acute Renal Failure

一位62歲男性在服用allopurinol 9天之後因為發高燒和全身出現紅疹而被送到急診室。身體物理檢查除了全身紅疹之外，其餘均正常。完整血球數目檢查結果呈現白血球數目增多且有噬伊紅血球症的現象。血液生化檢查則顯示有不正常的肝腎功能。住院後此病患接受皮膚切片檢查，病理診斷為多形性紅斑。這些以上的發現均符合allopurinol hypersensitivity syndrome (AHS)之診斷條件。不幸的是儘管迅速停止allopurinol的服用和接受輸液以及類固醇治療，他仍因為急性腎衰竭接受了8次間斷性的血液透析治療才存活下來。而且最差的情況是他的腎臟功能並沒能完全恢復！因此當病人在使用allopurinol後有過敏的現象而且合併急性腎衰竭及肝衰竭時，allopurinol過敏症候群(AHS)應該被考慮。

關鍵字

allopurinol過敏症候群；多形性紅斑；急性腎衰竭

並列摘要

A 62-year-old male was sent to the emergency room due to a high fever and generalized skin rash after taking allopurinol for 9 days. Physical examination was normal except for the generalized skin rash presenting with erythematous macules. Complete blood count showed leukocytosis with eosinophilia. Blood biochemistry showed impaired renal and hepatic function. Pathologic examination concluded that the skin rash was erythema multiforme. These findings met the diagnostic criteria for allopurinol-induced hypersensitivity syndrome (AHS). Our patient not only had the most common skin lesion but soon developed acute renal failure that required intermittent hemodialysis, despite rapid discontinuation of allopurinol and adequate hydration and steroid therapy. No other causes of acute renal failure were found. Renal impairment was the worst part of the patient's condition and he never completely recovered. AHS should be considered in the differential diagnosis of acute renal and hepatic failure in patients with evidence of allergy and recent use of allopurinol.

並列關鍵字

allopurinol hypersensitivity syndrome ； erythema multiforme ； acute renal failure

國際替代計量

Allopurinol-Induced Severe Hypersensitivity with Acute Renal Failure

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