Allopurinol/bevacizumab interaction
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Toxic epidermal necrolysis: case report A 56-year-old man developed toxic epidermal necrolysis during treatment with allopurinol for arthritis, and following a single injection of bevacizumab for macular degeneration. He later died. The man was admitted with painful rash involving his chest, arms and abdomen. He had blistering and epidermal detachment, mouth ulcers, and conjunctival inflammation. Blood urea, creatinine and liver enzymes were elevated. He had been diagnosed with acute arthritis 3 months earlier, and had begun receiving allopurinol 100 mg once a day [route not stated]. More recently, he had reported diminished vision in one eye, and been diagnosed with exudative age-related macular degeneration. He had received intravitreal bevacizumab 1.5mg and, 6 days after this, his painful rashes had developed. As more than 30% of his epidermis had detached, he was diagnosed with toxic epidermal necrolysis due to allopurinol hypersensitivity. The man received crystalloid, methylprednisolone and ticarcillin/clavulanic acid. Allopurinol was stopped, but his lesions persisted and his renal function worsened. He was transferred to a nephrology ward but he died on hospital day 10. Author comment: "Causality assessment of the adverse drug reaction (ADR) using the World Health OrganisationUppsala Monitoring Centre criteria suggested a ’possible’ relationship with allopurinol administration. . . We considered that bevacizumab must have potentiated the reaction, possibly amplifying the ADR by modulating the immune system." Padhy BM, et al. An unusual case of allopurinol hypersensitivity syndrome potentiated by intravitreal bevacizumab. European Journal of Clinical Pharmacology 67: 537-538, No. 5, May 2011. Available from: URL: http:// 803055032 dx.doi.org/10.1007/s00228-010-0945-8 - India
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Reactions 4 Jun 2011 No. 1354
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