Allopurinol-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome: A Cause of Acalculous Cholecystitis?

Abstract

Acalculous cholecystitis (AC) is an inflammation of the gallbladder in the absence of gallstones. There are many risk factors associated with AC. However, this report implicates allopurinol as an inciting agent for a severe systemic drug reaction, i.e., the drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome complicated by AC. We report a Chinese woman who presented on two occasions with a diffuse maculopapular rash, elevated liver enzymes, and upper abdominal pain attributable to acute AC, the second episode of which developed after the reintroduction of allopurinol treatment for gout. The AC complicated the DRESS syndrome during the course of her hospitalization.

Keywords: acalculous cholecystitis; allopurinol; dress syndrome; hypersensitivity; new entity.

Figure 1. Rash on lower extremities at the time of presentation

Figure 2. Rash on upper extremity at the time of admission

Figure 3. Resolving erythematous lesions on lower limbs at the time of discharge

Figure 4. Resolution of rash on upper limb at discharge