Paradoxical increase in uric acid level with allopurinol use in pyrazinamide-induced hyperuricaemia

Gerdan V, Akkoc N, Ucan ES, Bulac Kir S
Correspondence: Prof Nurullah Akkoc, nurullah.akkoc@gmail.com

ABSTRACT
We report the case of a 36-year-old man with psoriatic arthritis and miliary tuberculosis, whose serum uric acid (SUA) level increased after the initiation of antituberculosis treatment, which included pyrazinamide. Most strikingly and paradoxically, the patient’s SUA level increased after treatment with allopurinol. On cessation of allopurinol, his SUA level decreased substantially, and complete normalisation was observed following the discontinuation of pyrazinamide treatment.

Keywords: allopurinol, antitubercular agents, tuberculosis, uric acid
Singapore Med J 2013; 54(6): e125–e126; http://dx.doi.org/10.11622/smedj.2013097

http://smj.org.sg/sites/default/files/5406/5406cr3.pdf

REFERENCES

1. Kutzing MK, Firestein BL. Altered uric acid levels and disease states. J Pharmacol Exp Ther 2008; 324:1-7. http://dx.doi.org/10.1124/jpet.107.129031

2. Taki H, Ogawa K, Murakami T, Nikai T. Epidemiological survey of hyperuricemia as an adverse reaction to antituberculous therapy with pyrazinamide. Kekkaku 2008; 83:497-501.

3. Postlethwaite AE, Bartel AG, Kelley WN: Hyperuricemia due to ethambutol. N Engl J Med 1972; 286:761-2. http://dx.doi.org/10.1056/NEJM197204062861407

4. Khanna BK, Gupta VP, Singh MP. Ethambutol-induced hyperuricaemia. Tubercle 1984; 65:195-9. http://dx.doi.org/10.1016/0041-3879(84)90075-8

5. Sharma TN, Jain NK, Mathur BB, et al. Hyperuricemia and arthralgia during pyrazinamide therapy. Indian J Tuberc 1981; 28:92-96.

6. Shapiro M, Hyde L. Hyperuricemia due to pyrazinamide. Am J Med 1957; 23:596-9. http://dx.doi.org/10.1016/0002-9343(57)90230-9

7. Inoue T, Ikeda N, Kurasawa T, et al. [Hyperuricemia and arthralgia during pyrazinamide treatment]. Nihon Kokyuki Gakkai Zasshi 1999; 37:115-8. Japanese. http://dx.doi.org/10.7144/sgf.5.115

8. Migliori GB, Raviglione MC, Schaberg T, et al. Tuberculosis management in Europe. Task Force of the European Respiratory Society (ERS), the World Health Organisation (WHO) and the International Union against Tuberculosis and Lung Disease (IUATLD) Europe Region. Eur Respir J 1999; 14:978-92. http://dx.doi.org/10.1183/09031936.99.14497899

9. Becker MA. Asymptomatic hyperuricemia. In: UpToDate Inc [online]. Available at: http://www.uptodate.com/contents/asymptomatichyperuricemia. Accessed October 1, 2012.

10. Petty TL, Dalrymple GV. Inhibition of pyrazinamide hyperuricemia by small doses of acetylsalicylic acid. Ann Intern Med 1964; 60:898-900. http://dx.doi.org/10.7326/0003-4819-60-5-898

11. Qureshi W, Hassan G, Kadri SM, et al. Hyperuricemia and arthralgias during pyrazinamide therapy in patients with pulmonary tuberculosis. Lab Med 2007; 38:495-7. http://dx.doi.org/10.1309/7GBYQTY62PFEHDP1

12. Horsfall PA, Plummer J, Allan WG, et al. Double blind controlled comparison of aspirin, allopurinol and placebo in the management of arthralgia during pyrazinamide administration. Tubercle 1979; 60:13-24. http://dx.doi.org/10.1016/0041-3879(79)90051-5

13. Lacroix C, Guyonnaud C, Chaou M, Duwoos H, Lafont O. Interaction between allopurinol and pyrazinamide. Eur Respir J 1988; 1:807-11.