Severe cutaneous reaction due to terazosin

A 56-year-old white man consulted us with a generalised rash that had occurred 3 days after being started on terazosin 2 mg/day for benign prostatic hyperplasia. His medical and family history was unremarkable, and he had not taken any other medication. He had mild fever and asthenia, and pruritus was intense. We saw a widespread eruption of scaling erythematous plaques with a violaceous hue on the trunk (figure) and extremities, affecting his palms and soles but sparing the mucous membranes. The lesions had sharp borders and covered almost the entire body surface, with patches of normal skin among them. We noted non-specific inguinal lymphadenopathy, but the remainder of clinical examination was normal. Haematological and biochemical parameters, including liver-function tests, were normal, except for mild leucocytosis (leucocytes 14·4 10/L, eosinophils 1·4 10/L) and a slightly raised erythrocyte sedimentation rate (25 mm/h). Serological tests for antinuclear antibodies, rheumatoid factor, syphilis, hepatitis B and C, and EpsteinBarr virus were all negative. Histopathological assessment of a skin biopsy sample showed a pattern suggestive of a drug reaction, consisting of subtle basal spongiosis and mild lymphocytic exocytosis, with some apoptotic keratinocytes in the basal epidermal layer. In addition, a mild perivascular lymphocytic infiltrate with scant eosinophils was present in the upper dermis. Terazosin was stopped, and treatment with oral methylprednisolone (40 mg/day) and emollients resulted in complete recovery in 2 weeks. Terazosin is a long-acting -1 selective blocking agent that was used originally for treatment of hypertension. Multicentre placebo-controlled studies have reported its efficacy in benign prostatic hypertrophy. The rare and usually mild adverse effects related to the drug’s pharmacological action are dose-related and include headache, dizziness, and asthenia. Adverse cutaneous reactions are rare, although non-specific mild rashes have been occasionally reported. In view of the clear temporal relation between the onset of terazosin therapy and the cutaneous eruption and the resolution of the skin lesions when terazosin was 95