Stevens-Johnson Syndrome Due to Allopurinol with Positive DLST to Several Other Drugs

Abstract

A 37-year-old man with lumbago had been taking diclofenac (Blesin^®), quercus salicina extract (Urocalun^®) and rebamipide (Mucosta^®) from January 14, 2004, and allopurinol (Zyloric^®), colestimide (Cholebine^®) and bezafibrate (Bezalip^®) for hyperlipidemia from January 19, 2004. On February 1st, he developed a high fever, general fatigue, toothache, edema of the lips, and erythema on the genital areas, palms, and soles. On February 4th, he developed gait disturbance because of swelling of his hands and feet and dyspnea. Using methylpredonisolone pulse therapy and oral predonisolone (PSL), his fever was reduced to normal after a week, the vesicles and bullae of the genital areas, hands, and feet diminished after three weeks, and the erythema and oral erosion improved after a month. A biopsy of the erythema of the left foot showed a large number of necrotic keratinocytes in the epidermis and subepidermal bulla formation. The result of a closed patch test (PT) with Zyloric^® on the lesional area was positive. A drug-induced lymphocyte stimulation test (DLST) with some of the suspected drugs was serially measured. High positive reactions to the DLST for Zyloric^®, Cholebine^®, Bezalip^® and diclofenac continued for half a year. There was an elevation of the antibody titers of mycoplasma in his serum. We diagnosed our case as Stevens-Johnson syndrome due to Zyloric^® because of the positive results of both the PT and the DLST.