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July 2014

Allopurinol Overuse in Asymptomatic Hyperuricemia: A Teachable Moment

Author Affiliations
  • 1Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital “Luigi Sacco,” Università di Milano, Milan, Italy
  • 2Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy
  • 3Scientific Institute, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Eugenio Medea, Lecco, Italy
JAMA Intern Med. 2014;174(7):1031-1032. doi:10.1001/jamainternmed.2014.1427

Screening for plasma uric acid is widespread in many countries including Italy. This is based on the assumption that alongside gout, hyperuricemia may be associated with and contribute to several cardiovascular, renal, and metabolic disorders, although evidence of the clinical utility of such routine screening is still scant.1

An 81-year-old woman was found to have serum uric acid and creatinine concentrations of 6.6 mg/dL and 2.31 mg/dL, repectively (to convert to micromoles per liter, multiply by 59.485 for uric acid and by 88.4 for creatinine), on a routine screening test. The clinical examination revealed no major health problems and no history or examination findings suggestive of gout. She received a diagnosis of asymptomatic hyperuricemia, for which she was treated with 150 mg/d of allopurinol. Immediately after the first administration of allopurinol, the patient developed a severe hypersensitivity reaction, her clinical condition worsened significantly, and despite treatments she died a few days after admission to the hospital.