Acute immunoallergic hepatitis due to allopurinol use

Area of Science:

• Hepatology
• Clinical Pharmacology
• Immunodermatology

Background:

• Acute immunoallergic hepatitis is a drug-induced liver injury often presenting with fever, rash, and abdominal pain.
• Allopurinol is a known cause of drug-induced liver injury, including severe immunoallergic hepatitis and DRESS syndrome.
• The HLA-B58*01 gene is a significant risk factor for allopurinol-induced liver injury.

Observation:

• A young East Asian male with gout developed acute immunoallergic hepatitis and DRESS syndrome after allopurinol intake.
• The patient was positive for the HLA-B58*01 gene.
• The patient presented with severe cutaneous reactions and liver injury.

Findings:

• Allopurinol intake led to acute immunoallergic hepatitis and DRESS syndrome in an HLA-B58*01 positive patient.
• Intravenous methylprednisolone followed by oral prednisone resulted in improvement of liver injury and skin reactions.
• Early corticosteroid administration is vital for managing allopurinol-induced severe cutaneous adverse reactions and liver damage.

Implications:

• Clinicians should exercise caution when prescribing allopurinol, particularly in high-risk populations like East Asian males with the HLA-B58*01 gene.
• Prompt recognition and early corticosteroid treatment are essential to prevent severe liver damage and long-term complications.
• This case highlights the importance of pharmacogenetic screening for HLA-B58*01 before initiating allopurinol therapy.