Allopurinol vasculitis with

The possible drug-induced causes of ANCA-positive vasculitis with high titers of antimyeloperoxidase antibodies in 30 new patients have been reviewed (65). The findings illustrated that this type of vasculitis is a predominantly drug-induced disorder. Only 12 of the 30 cases were not related to a drug. The most frequently implicated drug was hydralazine (n = 10) the remainder involved propylthiouracil (n = 3), penicillamine (n = 2), allopurinol (n = 2), and sulfasalazine (n = 1). 

Jarzobski J, Ferry J,Womboldt D, Fitch DM, Egan JD Vasculitis with allopurinol therapy. Am Heart J 1970 79 116-121. KantorGC.Toxic epidermal necrolysis, azotemia, and death afterallopurinol therapy. JAMA 1970 212 478-479. 

The major side effects of allopurinol are skin rash, urticaria, leukopenia, GI problems, headache, and increased frequency of acute gouty attacks with the initiation of therapy. An allopurinol hypersensitivity syndrome characterized by fever, eosinophilia, dermatitis, vasculitis, and renal and hepatic dysfunction occurs rarely but is associated with a 20% mortality rate. 

Choi HK, Merkel PA, Niles JL. ANCA-positive vasculitis associated with allopurinol therapy. Clin Exp Rheumatol 1998 16(6) 743. ... 

Allopurinol is the antihyperuricemic drug of choice in patients with a history of urinary stones or impaired renal function, in patients who have lymphoproliferative or myeloproliferative disorders and need pretreatment with a xanthine oxidase inhibitor before initiation of cytotoxic therapy to protect against acute uric acid nephropathy, and in patients with gout who are overproducers of uric acid. The major side effects of allopurinol are skin rash, leukopenia, occasional gastrointestinal toxicity, and increased frequency of acute gouty attacks with the initiation of therapy. An allopurinol hypersensitivity syndrome characterized by fever, eosinophilia, dermatitis, vasculitis, and renal and hepatic dysfunction is a rare side effect, but is associated with a 20% mortality rate. ... 

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