Atlopurinol-induced drug rash with eosinophifia and systemic symptoms mimicking acute generalized exanthematous pustulosis

摘要

We were consulted for a 65-year-old Han Chinese man presenting with generalized skin eruption of 12 days' duration and high fever of 3 days'. Physical examination showed generalized follicular pustules on confluent erythematous maculo-papular bases over the scalp, face, trunk and upper extremities with palpable purpura over lower extremities (Fig. 1). No lymphadenopathy or mucosal lesions were noted. According to the patient, erythematous rashes appeared first then pustules developed approximately 10 days later. He had received a new drug (allopurinol) for hyperuricemia 1 month before the skin rash developed. Laboratory tests revealed leu-kocytosis (white blood cell count, 16 410/uL) containing marked eosinophilia (4759/uL), elevated liver enzymes (aspar-tate aminotransferase, 404 IU/L; alanine aminotransferase, 667 IU/L).