Stevens-Johnson syndrome induced by co-administration of Allopurinol and Colchicine

INTRODUCTION: Stevens-Johnson syndrome (SJS) is a rare, life-threatening drug-induced cutaneous reaction.Drugs are an important cause of Stevens-Johnson syndrome CASE REPORT: A 27 year old male was on treatment for hyperuricemia with allopurinol 100mg BD and colchicine 0.5mg BD. After 15 days he presented to emergency department complaining of pain over both eyes, erosions on the lips, soft palate and genitalia, raised erythematous skin lesions over neck and trunk since 2 days. SJS was diagnosed. All treatment was discontinued and patient was treated. Lesions regressed after one week. DISCUSSION: Here diagnosis was straight forward as he had severe ocular and oral involvement as well as skin lesions which were characteristic for SJS. Suspected culprit drugs in our case are allopurinol and colchicine. However cutaneous reactions to colchicine is infrequent. Allopurinol hypersensitivity is infrequent but life threatening. The mechanism may involve immunologic factors (type IV reaction) and genetic predisposition. Rechallenge is contraindicated in a severe reaction. There are published studies on allopurinol induced SJS alone in elderly persons but to our knowledge this is the first description of SJS induced in a young adult. CONCLUSION: Its incidence can be reduced by starting with low dose of allopurinol. Patients who develop SJS are in a precarious condition, and their management entails a great deal of vigilance. Fortunately, in this case appropriate surveillance led to considerable recovery.