Allopurinol causing drug rash with eosinophilia and systemic symptoms syndrome: a challenging diagnosis

Figures & data

Figure 1 Scaling of the diffuse confluent erythema all over the patient’s face.

Figure 2 Macular lesions all over the trunk.

Figure 3 Spreading of the rash symmetrically to the lower extremities, purpuric type.

Figure 4 Chest X-ray: left lower lobe atelectasis with bilateral interstitial infiltrates.

Table 1 Patient’s laboratory data

Date	WBCs/PMNs (*10^9/L)	Eosinophils	BUN/Cr (mg/dL)	ALT/AST (U/L)	Alk ph/GGT (U/L)	INR
7/31/09	8500/68%	12%	19/1.7	210/165	80/133
8/2/09	21,300/62%	16%	59/2.4	476/309	85/141	1.44
8/8/09	15,000/91%	1%	34/1.22	168/75	227/503	1.38
8/13/09	12,500/75%	0%	31/1.12	70/76	114/514	1.28

Abbreviations: ALT, alanine transaminase; AST, asparte aminotransferase; BUN, blood urea nitrogen; Alk ph, alkaline phosphatase; GGT, gamma-glutamyl transferase; INR, international normalized ratio; Cr, creatinine; WBCs, white blood cells; PMNs, polymorphonuclear cells.