Allopurinol hypersensivity syndrome presenting as cutaneous lymphoma

Abstract

Adverse cutaneous reactions to drugs are frequent (2 to 3 percent of hospitalized patients); although most are not severe, afew are related with high ra­tes of morbility and mortality. Rapid recognition of severe reactions is essencial, such as Stevens-john­ son syndrome, toxic epidermal, necrolysis and hyper­ sensitivity syndrome. The drugs most often respon­sible for the hypersensitivity syndrome are anticon­vulsants, sulphonamides and allopurinol Hypersen­ sitivity syndrome induced by drugs in rare instan­ces present clinical characteristics and even a histo­logic picture indistinguishable from true cutaneous lymphoma. ln these cases the differentiation betwe­en the two clinical entities although difficult, is very important due to the natural therapeutic implicati­ons.

The authors present a 51-years old patient with rapid installation of high fever and erythroderma. The histologic findings of the cutaneous and lymphode biopsies were of cutaneous T-cell lymphoma with specific lymph node involvement. However, we were informed that the patient had been medicated with allopurino two weeks before the symptoms. The clinical and analytical characteristics and the clini­cal evolution, confirmed the diagnosis of allopurinol hypersensitivity syndrome.