A Life-Threatening Adverse Drug Reaction: Allopurinol-Induced Stevens–Johnson Syndrome in a Patient with Gout and Hypertensive Heart Disease: A Case Report

Abstract

Background

Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but life-threatening immune-mediated mucocutaneous disorders characterized by extensive keratinocyte apoptosis, resulting in epidermal detachment and mucosal involvement. Allopurinol, a xanthine oxidase inhibitor primarily used to manage chronic gout and hyperuricemia, is globally recognized as one of the most frequent causative agents of SJS and TEN. The risk of such adverse drug reactions is increased in patients with comorbidities such as chronic kidney disease and hypertensive heart disease, where altered drug clearance and cardiovascular fragility complicate both disease pathogenesis and management. This report highlights the clinical challenges of managing allopurinol-induced SJS in a patient with cardiovascular comorbidity.

Case Report

A 58-year-old female with chronic tophaceous gout and hypertensive heart disease developed SJS approximately 18 days after initiating allopurinol 300 mg daily. She presented with high-grade fever, malaise, and rapidly progressive erythematous eruptions with dusky macules and flaccid bullae involving 9% of total body surface area. Severe mucosal involvement affected the oral, conjunctival, and genital regions. Histopathology confirmed full-thickness epidermal necrosis. Management in a high-dependency unit required careful balance between fluid resuscitation and strict volume control. Following drug withdrawal, systemic corticosteroids, and supportive care, complete re-epithelialization was achieved within three weeks.

Conclusion

Early recognition, prompt cessation of the offending drug, and multidisciplinary care are essential. In patients with cardiovascular comorbidities, fluid management must be carefully individualized to prevent complications while maintaining adequate organ perfusion.