Paradoxical Hyperhemoglobinemia

Case Report

Austin Intern Med. 2016; 1(2):1008.

Paradoxical Hyperhemoglobinemia

Wu K¹*, Hu B², Chen H³ and Sun JF³

¹Zhuhai Xiguang General Clinic, China

²Department of Dermatology, Wuhan No.1 Hospital, China

³Department of Pathology, Peking Union Medical College, China

*Corresponding author: Kan Wu, Zhuhai Xiguang General Clinic, 172 Renminxi St, Zhuhai, 519000, China

Received: July 28, 2016; Accepted: August 23, 2016; Published: August 25, 2016

Abstract

A 63-year-old male presented with disseminated targetoid erythema and blisters consistent with erythema multiforme on first sight, he was recently treated with allopurinol for primary uric acid nephropathy by his nephrologist. Though his serum creatinine was in the range of stage 3 chronic kidney disease, the man did not show paleness like usual patients within that group, who might suffer from nephrogenic anemia. Paradoxically, the man appeared plethoric and routine blood test found elevated hemoglobin, red blood cell count and mean corpuscular hemoglobin levels. This rare phenomenon lead to the suspicion of polycythemia vera and later confirmed by bone marrow biopsy. Which means the man was not suffering from primary uric acid nephropathy but secondary to polycythemia vera, a disease that increases erythropoiesis and nucleic acid synthesis. Hydroxyurea instead of allopurinol is what he really needs.

Keywords: Polycythemia vera; Allopurinol; Erythema multiforme; Uric acid nephropathy; Chronic kidney disease

Introduction

Erythema Multiforme (EM) is a skin condition that considered to be a hypersensitivity reaction to infections or drugs, it is not an orphan disease, but we encountered a gentleman presented with EM and a series of other co-morbidities, though rare, they together formed a possibly reproducible clinical scenario that might be seen in any health care providing facility, we believe it is worth noticing.

Case Presentation

A 63-year-old male presented with disseminated painful targetoid erythema and blisters consistent with EM on first sight. He was afebrile, and upon questioning he admitted taking allopurinol 200mg daily recently prescribed by his nephrologist for uric acid nephropathy. Except for hyperuricemia and stage 3 Chronic Kidney Disease (CKD) he was believed to be otherwise healthy. But suspiciously, he appeared too “red” for stage 3 CKD, who might develop nephrogenic anemia and appears faint and pale.

On clinical examination, there was disseminated painful swollen targetoid erythema, some with center blistering (Figure 1). The patient appeared plethoric (Figure 2) when compared to a healthy individual (Figure 3).