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Teachable Moment
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August 6, 2018

HLA-B*5801 Testing to Prevent Allopurinol Hypersensitivity SyndromeA Teachable Moment

Author Affiliations
  • 1Albert Einstein College of Medicine and Montefiore Medical Center, Department of Internal Medicine, Residency Training Program, Bronx, New York
  • 2Albert Einstein College of Medicine and Montefiore Medical Center, Department of Internal Medicine, Division of Hospital Medicine, Bronx, New York
JAMA Intern Med. Published online August 6, 2018. doi:10.1001/jamainternmed.2018.3556

A 77-year-old man of Asian descent with chronic stage 3 kidney disease, gout, and hypertension was admitted with 3 days of fever, myalgia, and cutaneous eruption. On examination he was febrile to 102.3°F and had a diffuse maculopapular eruption over his trunk and arms. Initial laboratory results indicated leukopenia with mild eosinophilia and alanine aminotransferase and aspartate aminotransferase levels of 308 U/L and 248 U/L, respectively. He had been prescribed allopurinol, 300 mg daily, and colchicine, 0.6 mg daily, 1 month earlier given frequent attacks of acute gouty arthritis. Drug rash with eosinophilia and systemic symptoms (DRESS) was suspected and allopurinol was discontinued. Blood testing for HLA-B*5801 by polymerase chain reaction had a positive result. Despite steroid therapy his condition worsened, and his course was complicated by bronchiolitis, acute kidney injury, and small bowel perforation requiring multiple abdominal surgeries. He was discharged after more than 2 months in the hospital.

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