Mr Amin was a cheerful 65-year-old retiree with diabetes and high blood pressure. One morning his son found him unconscious and rushed him to the hospital. At the emergency department, tests showed high blood pressure, high cholesterol, high blood sugar, reduced kidney function, and high uric acid. After a short hospital stay, Mr Amin was sent home with prescriptions for insulin, a cholesterol medicine, and four types of blood pressure medicine. The high uric acid, which is sometimes but not always associated with gout, was not treated.
Not long afterward, Mr. Amin went for a follow-up visit at his regular primary care centre. Because Mr Amin’s uric acid level had not gone down, the primary care practitioner gave him a prescription for allopurinol, a powerful drug that reduces uric acid. Mr Amin soon developed a severe skin rash, which rapidly became worse. His family took him back to the emergency department, where he was diagnosed with Stevens Johnson Syndrome. Stevens Johnson Syndrome is a dangerous condition in which the upper layers of the skin and mucous membranes peel off. It is a known and feared side effect of the drug allopurinol. Mr Amin died in the hospital a few days later.
While allopurinol is the drug of choice for lowering uric acid in gout, the risk of Stevens Johnson Syndrome and other rare but serious drug reactions cannot be ignored. Clinical practice guidelines in Mr Amin's country advise against using allopurinol in patients like Mr Amin, who have no external signs of gout. Furthermore, patients taking high-risk drugs like allopurinol should be told what to do if they have a reaction. This did not happen in the case of Mr Amin, who believed he had chicken pox and did not know to stop taking the drug.
*The names and photos used in this story are not real, but the story is based on true events.