Abstract: CHEN Ling-ling, LU Dan-dan, SHI Xin*, SUN Xiao-dong, XIE Li-xia, CHEN Xiao-jian, DING Lan, JIN Wei-jia, WANG Yong-fei. *Department of Dermatology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China Corresponding author: SHI Xin, Email: shx9@163.com 【Abstract】 A case of allopurinol-induced drug rash with eosinophilia and systemic symptoms successfully controlled by tumor necrosis factor-α （TNF-α） antagonist is reported. A 60-year-old man with gout and diabetes was admitted to the hospital for generalized pruritic eruptions with fever for four days. Twenty days prior to the presentation he was given oral allopurinol for the treatment of gout, and four days before the admission, he developed generalized exfoliative dermatitis complicated by fever, liver and kidney damage, leukocytosis, eosinophilia and lymph node enlargement. After the admission, he was treated with subcutaneous injection of recombinant human TNF-α receptor Ⅱ once every other day with the initial dose being 50 mg/d and maintenance dose 25 mg/d. The patient healed after eight sessions of injection. In detail, fever dropped and was controlled immediately after the first injection, epidermal detachment stopped within 24 hours, desquamation began two days later, and re-epithelization started five days later. The serum level of TNF-α descended gradually and reached the normal range on week 5 after the beginning of treatment. White blood cell count as well as C-reactive protein and bilirubin levels in peripheral blood still continued to increase after the admission, began to decrease after three injections, and dropped gradually to the normal range within two weeks. Serum aminotransferase levels started to decrease after the first injection and returned to the normal range within two weeks. Peripheral eosinophil count continuously increased after the first injection, reached its peak on day 10, dropped gradually thereafter, and was restored to the normal range five weeks after the initiation of treatment. This case suggests that TNF-α antagonist used at early stage can control drug rash with eosinophilia and systemic symptoms rapidly, safely and effectively, but cannot prevent the increase of eosinophils. 【Key words】 Dermatitis, exfoliative; Tumor necrosis factor-α; Treatment outcome