Rheumatology: allopurinol hypersensitivity: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: allopurinol hypersensitivity

Sample item

A 60-year-old man with gout and chronic kidney disease starts allopurinol 300 mg daily. After 4 weeks he develops fever, a widespread rash, eosinophilia, abnormal liver enzymes and a rising creatinine. Which genetic marker predisposes to this reaction?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. HLA-B*58:01

Allopurinol hypersensitivity syndrome (DRESS or Stevens-Johnson spectrum) is more frequent with renal impairment, high starting doses and the HLA-B*58:01 allele, which is common in Han Chinese, Thai and some Asian populations. The drug must be stopped permanently, and starting doses should be low (50 to 100 mg) and titrated. Febuxostat is an alternative urate-lowering option.

Option by option

  • A. HLA-B*57:01

    HLA-B*57:01 predicts abacavir hypersensitivity.

  • B. HLA-B*58:01 (correct)

    Correct. HLA-B*58:01 carriage strongly predicts severe allopurinol reactions.

  • C. HLA-B*15:02

    HLA-B*15:02 predicts carbamazepine-induced Stevens-Johnson syndrome in Southeast Asians.

  • D. HLA-DRB1*04

    HLA-DRB1*04 is associated with rheumatoid arthritis susceptibility.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, HLA-B*58:01. Allopurinol hypersensitivity syndrome (DRESS or Stevens-Johnson spectrum) is more frequent with renal impairment, high starting doses and the HLA-B*58:01 allele, which is common in Han Chinese, Thai and some Asian populations.

Why is "HLA-B*57:01" not the answer?

HLA-B*57:01 predicts abacavir hypersensitivity.

Why is "HLA-B*15:02" not the answer?

HLA-B*15:02 predicts carbamazepine-induced Stevens-Johnson syndrome in Southeast Asians.

Why is "HLA-DRB1*04" not the answer?

HLA-DRB1*04 is associated with rheumatoid arthritis susceptibility.

What concept does this question test?

It tests Rheumatology: allopurinol hypersensitivity in General Medicine. The drug must be stopped permanently, and starting doses should be low (50 to 100 mg) and titrated. Febuxostat is an alternative urate-lowering option.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: allopurinol hypersensitivity?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.