Conclusion
Allopurinol-induced granulomatous hepatitis is a rare phenomenon that rheumatologists should be aware of given the frequency with which this drug is used. A discovery of this condition should prompt a change in therapy to another urate-lowering agent, such as febuxostat, which has not had any reported cases of granulomatous hepatitis.
This case serves as a reminder that any clinical presentation without a clear etiology warrants a review of the patient’s medication list. It is not possible to know every rare, adverse reaction to medications, but identifying a temporal relationship between a drug and a clinical presentation can help guide our clinical suspicions.
Raj Vachhani, MD, is a third-year postgraduate, studying internal medicine at the University of Alabama, Birmingham.
Angelo L. Gaffo, MD, MSPH, is the rheumatology section chief at the Birmingham VA Medical Center and associate professor of medicine in the Division of Rheumatology at the University of Alabama, Birmingham.
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