Drug-induced hypersensitivity syndrome due to fluindione

Background. Fluindione (Previscan (R)) is an oral anticoagulant prescribed in relay to heparin therapy for deep venous thrombosis, pulmonary embolism. .. The main complications with oral anticoagulants are bleeding, However, s evere immuno-allergic complications, especially acute hepatitis, acute rena l failure and acute bone marrow failure, have been described with phenindio ne therapy. Observations. The authors report herein the first five cases of drug-induce d hypersensitivity syndrome due to fluindione. Clinical signs included eryt hroderma and severe systemic manifestations which occured within 3 to 8 wee ks after introducing the molecule. Sex ratio was four males for one female; their ages ranged from 53 to 84 years. Clinical signs included erythroderm a (with photosensitivity in two patients), lymphadenopathy and fever evokin g severe sepsis. In our observations, marked eosinophilia (5 cases), lympho cytosis, atypical lymphocytes (4 cases), hepatic cytolysis (4 cases), assoc iated in 2 cases with hepatic cholestasis, and pulmonary signs were noted. Cutaneous eruption healed in about 3 to 6 weeks after withdrawal of the dru g. in two cases, systemic steroids were required for the severity of system ic manifestations. Long after the acute episode and when steroids were stop ped, patch testing with fluindione was still positive. Discussion. To date, acute and/or severe skin diseases due to fluindione, a ssociated or not with multisystemic involvement, have never been reported. This molecule is the most commonly used for the treatment of thromboembolic diseases, Patch testing is easy to perform and can help physicians Find th e responsible molecule. Moreover, skin manifestations are present only in 8 7 P.100 of drug-induced hypersensitivity syndromes, Acute hepatitis and acu te renal failure might be drug-induced hypersensitivity syndromes without c utaneous manifestations.