1f:T47f,Allopurinol, introduced in 1963,¹has proved to be a useful agent for the treatment of gout and hyperuricemia.^2-7Although serious toxicity has been unusual, recent case reports of agranulocytosis,⁸granulomatous hepatitis,⁹and exfoliative dermatitis¹⁰have appeared. In addition, four cases have been reported of severe, prolonged hypersensitivity reactions characterized by an erythematous maculopapular eruption, eosinophilia, fever, abnormal results of liver-function tests, and rapidly progressive renal failure.^11-13The purpose of this communication is to describe two further cases of apparent hypersensitivity vasculitis and to explore possible predisposing factors.

Patient Summaries

Patient 1.

Patient Summaries

Patient 1.

—A 40-year-old black man was admitted to Vanderbilt University Hospital on April 14,1971, with a chief complaint of skin rash and fever. The patient's course had been followed at Vanderbilt since 1953 for psychomotor seizures, controlled with diphenylhydantoin sodium and phenobarbital. In 1963, during an evaluation for hypertension (blood pressure, 180/110 mm Hg),21:T47d,The frequency of severe reactions to allopurinol has probably been underestimated. A retrospective study encompassing a five-year period has yielded 20 patients with severe hypersensitivity reactions to allopurinol. Patients with preexisting renal impairment or who were receiving concomitant thiazide diuretics appeared to be especially predisposed. Cutaneous reaction patterns included maculopapular eruptions, exfoliative dermatitis, and toxic epidermal necrolysis. eosinophilia was uncommon. Forty percent of the patients developed hepatic involvement and 45% had renal involvement. Hepatic and renal changes usually were reversible and were not unique to any one cutaneous reaction pattern. Three patients with renal involvement required prolonged administration of systemic steroids. Complications included sepsis, decubitus ulcers, and thromboembolism. Two patients required hyperalimentation. Sequelae included dry eyes, pigmentary disturbances, and keloids. Three patients died as a result of their reaction. It is concluded that allopurinol should be used only in select patients, and the dosage should be modified if renal disease exists.

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