Abstract

A 58-year-old woman was admitted for heart failure and concern for cardiogenic shock. Laboratory evaluation was significant for impaired liver function tests and elevated blood urea nitrogen. The patient had been recently placed on colchicine and allopurinol, 4 months and 3 weeks respectively, prior to admission for presumed gout. The dermatology service was consulted for a cutaneous eruption that had started abruptly several days after allopurinol initiation. On exam, there were multiple erythematous papules with scant scale on the forearms and numerous dermally-based erythematous papules on the legs. The dermatology service favored a drug reaction and performed biopsies of both the thigh and forearm because of the varied morphologic presentation. Biopsy from the thigh demonstrated a lichenoid lymphocytic infiltrate with dyskeratosis and numerous intraepidermal mitoses predominantly in metaphase. In addition, there was a neutrophilic dermal infiltrate with leukocytoclasia suggesting a Sweet syndrome-like pattern. Biopsy from the forearm showed a superficial perivascular lymphocytic inflammation, in addition to dyskeratosis and intraepidermal mitotic figures, similar to what was observed in the thigh biopsy. However, no dermal neutrophilic infiltrate was present. An unusual drug eruption with concomitant features of colchicine toxicity and allopurinol associated Sweet-like reaction was favored. Both medications were halted and the patient was treated with topical steroids resulting in rapid resolution of the eruption. Colchicine toxicity is not a commonly encountered clinical scenario and cutaneous findings have only been rarely described. However, mitotic arrest, evidenced in both biopsies, is a known and documented mechanism of action of colchicine. In addition, allopurinol has been described in association with Sweet syndrome. To our knowledge, we report the first case of concurrent cutaneous colchicine effect with allopurinol-associated Sweet-like drug reaction.

Financial Disclosure: No current or relevant financial relationships exist.