Desensitization to allopurinol after allopurinol hypersensitivity syndromewith renal involvement in gout

This is a case report of a 36-year-old male with tophaceous gout for 16 yea rs. He started therapy with 300 mg/day of allopurinol. He had received vari able dexamethasone doses by self-prescription for 16 years. When allopurino l was initiated, he had hyperuricemia and normal renal function. Twenty day s after starting allopurinol, he presented diffuse maculopapular rash, conj unctivitis, increase in serum creatinine values, leukocytosis and eosinophi lia and the diagnosis of allopurinol hypersensitivity (AH) syndrome was mad e. He completely recovered from the AH and renal function normalized. Howev er, the gout worsened over the following years in spite of treatment with b enzobromarone, low doses of prednisone, and colthicine. Allopurinol desensitization was successful beginning with an oral low dose scheme (6.5 mu g/day) until we reached 300mg/day. Today the patient receive s allopurinol with no side effects. We believe that this is the first repor ted example of successful desensitization in full-blown AH with renal invol vement. Our cautious regimen might be tried in other such patients.