Clinical characteristics and outcomes of Allopurinol hypersensitivity syndrome at a Regional Referral Hospital in Bhutan: A Case Series

Abstract

Allopurinol, a first-line urate-lowering therapy for gout, may rarely cause severe hypersensitivity reactions, including Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS), collectively classified as severe cutaneous adverse reactions (SCARs). We report a case series of three patients with allopurinol-induced SCARs managed at a regional referral hospital in Bhutan, comprising SJS, SJS/TEN overlap, and DRESS/TEN overlap. Two elderly females with multiple comorbidities and one younger male developed symptoms within weeks of initiating allopurinol. All patients required hospitalization and were treated with systemic corticosteroids; intravenous immunoglobulin (IVIG) was administered in two cases. One patient died due to septic shock following secondary infection. These cases highlight the importance of early recognition, prompt discontinuation of the offending drug, and timely intervention. In resource-limited settings, risk assessment, supportive care, and infection control are critical to improving clinical outcomes.