Allopurinol-induced Sweet’s syndrome

Abstract

Sweet's syndrome, or acute febrile neutrophilic dermatosis, is an uncommon severe cutaneous condition, not previously associated with allopurinol therapy. We describe the case of an 87-year-old woman with hyperuricemia who developed classic Sweet's syndrome manifestations 8 days after being treated with allopurinol. Patient's symptoms included fever, painful edema in the hands and lower limbs with non-pruritic erythematous plaques topped by pus-filled skin blisters, right eye conjunctivitis, splenomegaly and joint pain. At the emergency department, blood tests showed neutrophilic leukocytosis, inflammatory state and altered liver function. During hospitalization, she received unsuccessful treatments with two different antibiotics (namely ceftriaxone and levofloxacin), while treatment with intravenous methylprednisolone produced a rapid clinical remission of symptoms, cutaneous lesion pain improvement, normalization of her body temperature and her blood values returned to normal. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient's development of Sweet's syndrome and allopurinol therapy. Because the signs and symptoms of Sweet's syndrome resemble an infectious process, the correct diagnosis may be delayed and inappropriate treatment regimen with antibiotics may often precede glucocorticoid therapy.

Adverse Drug Reactions in Hospitalized Patients: Results of the FORWARD (Facilitation of Reporting in Hospital Ward) Study

“…This difference is probably due to higher rate of parenteral antibiotics prescribed in Italy compared to the Northern European countries ( Davies et al, 2009 ). Moderate to severe skin/allergic reactions ( Polimeni et al, 2016 ) and application-site disorders represented the most common ADRs observed. These results might be partially explained by the higher rate of parenteral antibiotics among inpatients and the involvement of nurses and physicians in the project with a higher sensitiveness to identify ADRs.…”

Unusual drug reaction with features of colchicine toxicity in a patient on colchicine and allopurinol

“…Dermatologic complications of allopurinol can occur in up to 10%–15% of patients including a maculopapular eruption, pruritus, Sweet syndrome, and rarely, Stevens–Johnson syndrome/TEN 22 . Generally, the average duration from the administration of a causative agent to the onset of skin lesions is about 5–7 days in most cases 23–25 . Our patient presented 3 weeks after the initiation of allopurinol.…”

“…22 Generally, the average duration from the administration of a causative agent to the onset of skin lesions is about 5-7 days in most cases. [23][24][25] Our patient presented 3 weeks after the initiation of allopurinol. Given this time course, her skin eruption was initially presumed to be secondary to allopurinol.…”

Sweet’s Syndrome (SS) in the Course of Acute Myeloid Leukaemia (AML)

“…Sweet’s syndrome, or acute febrile neutrophilic dermatosis, is an uncommon, severe cutaneous condition, characterized by the abrupt development of painful, tender, erythematous plaques, fever greater than 38°C, and a nodular perivascular neutrophilic dermal infiltrate without evidence of vasculitis on histologic examination [ 1 ][ 3 ].…”

“…SS is a potentially disabling disease, significantly associated with malignancies (15-20% of cases). Among these, hematologic neoplasms, particularly acute myeloid leukaemia (AML) and myelodysplastic syndromes are the most commonly reported [ 2 ][ 3 ].…”