Beneficial Therapeutic Effect of Plasma Exchange Followed by Prednisolone for Drug-Induced Hypersensitivity Syndrome Caused by Allopurinol :

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The efficacy of plasma exchange for the treatment of severe drug eruption, such as toxic epidermal necrolysis or Stevens-Johnson syndrome, has been well established in many recent reports; however, that for drug-induced hypersensitivity syndrome (DIHS) has not yet to be clarified. We here report an 84-year-old woman with allopurinol-induced DIHS, who had taken a small dose of prednisolone for a long period for systemic lupus erythematosus. The patient developed widespread skin eruptions, fever, eosinophilia, liver injury, renal dysfunction and an increased antihuman herpes virus-6 IgG titer. She was successfully treated with plasma exchange, followed by 30 mg prednisolone. In the past 10 years in Japan, only 11 DIHS patients underwent plasma exchange and 10 patients survived. No cases except ours selected plasma exchange as an initial treatment, which followed by prednisolone. Plasma exchange should thus be considered for the treatment of an early stage of DIHS patients, especially those who are elderly or have frequent infections.

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