Concomitant Usage of Rasburicase and Allopurinol May Augment Toxic Epidermal Necrolysis Syndrome TEN

Abstract 4949

Rasburicase is used succesfully in conjunction with Allopurinol in the tratment and prevention of tumor lysis syndrrome. Rasburicase is a recombinant form of urate oxidase, which is an enzyme present in primates but not humans and convert uric acid to allantoin, which is five to ten time soluble than uric acid. This abstract represent our experience in four males patients, mean age is thirty five years, two with Acute Lymphoblastic Leukemia ALL and two patients with Burkitt's Lymphoma. Three patients has successful outcome in the treatment with Rasburicase followed by allopurinol. Only one patient with Burkitt's Lymphoma arising from congenital combined immunodeficiency syndrome who developed fatal Toxic Epidermal Necrolysis syndrome TEN. TEN is a relatively rare incidence and can be deadly. The mechanism of action is different for both drugs. In this patient Rasburicase was used initially with excellent reduction of uric acid levels, then patient was put latter on allopurinol. The TEN syndrome appeared after three days of initiating the drug and progressed rapidly. High dose Methotrexate and sever neutropenia may contributed to the fast progression and not respoding to steriods after allopurinol was stopped. Since this patient has combined humoral and cellular immunodeficiency with no recent administartion of immunoglobulins therapy, it is difficult to explain the allopurinol reaction based on any type of immune response, particulary type IV hypersensitivity reaction.

In conclusion: This particular case may draw the light on Rasburicase possible role in contribution or augumentation of TEN syndrome induced by allopurinol.