Allopurinol induced erythroderma
A 45-years-old male patient was admitted with complains of fever, redness and scaling all over the body for last 20 days. His recent drug history revealed that he was on oral allopurinol 200 mg daily for last 1½ month. He told that allopurinol was given by his general practitioner for increased uric acid level only. However when serum uric acid were repeated at our hospital the levels were normal. On further probing, he gave a history of generalized erythematous maculopapular rash along with a fever after 3 weeks of starting allopurinol, but he continued the medication. Later, there was the development of extensive erythema along with the scaling over the whole body within 4 days.\nOn examination, diffuse erythema with fine scaling was observed all over the body. Erythema and scaling were more pronounced over the trunk []. No significant lymphadenopathy or hepatosplenomegaly was observed. A skin biopsy done from back showed epidermal hyperplasia, foci of parakeratosis, spongiosis and a few necrotic keratinocytes. Dermis showed sparse superficial perivascular infiltrates consisting of lymphocytes and a few eosinophils. Laboratory investigations revealed raised liver enzymes (aspartate aminotransferase-114, alanine aminotransferase-112), but bilirubin was normal. Total blood counts including eosinophil count, renal function tests and serum electrolytes were within the normal limits. The causality was assessed using the Naranjo's adverse drug reaction probability scale. The association was “probable” as per the Naranjo's scale; hence, a diagnosis of allopurinol induced erythroderma was made. Allopurinol was stopped. Oral antihistamines and oral prednisolone 40 mg/day were started along with a supportive therapy. Patient improved over a period of 2 weeks [ showing improvement after 1week of treatment] and steroids were tapered and eventually stopped.