A 49-year-old female patient took febuxostat 20 mg once daily orally due to chronic kidney disease and hyperuricemia. On day 9 of medication, the patient developed facial hot flashes, and then purplish red maculopapules gradually appeared on the head, face, trunk, and both lower limbs. The rash were aggravated and spread gradually all over the body, involving the eyes, mouth, and vaginal mucosa. Lysis blisters appeared at the waist, and the area of epidermalysis was less than 10%. Laboratory tests showed white blood cell count 2.1×10 9/L, neutrophil count 1.7×10 9/L, hemoglobin 59 g/L, platelet count 97×10 9/L, C-reactive protein 105.6 mg/L; serum creatinine 1 062 μmol/L, and uric acid 647 μmol/L; human leukocyte antigen B*5801 allele was positive. Severe erythema multiforme induced by febuxostat was considered. Febuxostat was stopped immediately and treatments including protective isolation care, methylprednisolone, immunoglobulin, hemodialysis combined with hemoperfusion were given. On day 16 of treatments, black scab was found on the lip mucosa, and 30% skin scab peeled off. After 19 days of treatments, most of the scabs of whole body fell off, and new skin was visible. Laboratory tests showed that white blood cell count and platelet count returned to normal, C-reactive protein was 2.41 mg/L, serum creatinine was 582 μmol/L, and uric acid was 424 μmol/L.

A 49-year-old female patient took febuxostat 20 mg once daily orally due to chronic kidney disease and hyperuricemia. On day 9 of medication, the patient developed facial hot flashes, and then purplish red maculopapules gradually appeared on the head, face, trunk, and both lower limbs. The rash were aggravated and spread gradually all over the body, involving the eyes, mouth, and vaginal mucosa. Lysis blisters appeared at the waist, and the area of epidermalysis was less than 10%. Laboratory tests showed white blood cell count 2.1×10 9/L, neutrophil count 1.7×10 9/L, hemoglobin 59 g/L, platelet count 97×10 9/L, C-reactive protein 105.6 mg/L; serum creatinine 1 062 μmol/L, and uric acid 647 μmol/L; human leukocyte antigen B*5801 allele was positive. Severe erythema multiforme induced by febuxostat was considered. Febuxostat was stopped immediately and treatments including protective isolation care, methylprednisolone, immunoglobulin, hemodialysis combined with hemoperfusion were given. On day 16 of treatments, black scab was found on the lip mucosa, and 30% skin scab peeled off. After 19 days of treatments, most of the scabs of whole body fell off, and new skin was visible. Laboratory tests showed that white blood cell count and platelet count returned to normal, C-reactive protein was 2.41 mg/L, serum creatinine was 582 μmol/L, and uric acid was 424 μmol/L.