BackgroundInfectious etiology in lymphoproliferative diseases has always been suspected. The pathogenic roles of human herpesvirus-6 (HHV-6) in acute leukemia have been of great interest. Discordant results to establish a link between HHV-6 activation and the genesis of acute leukemia have been observed. The objective of this study was to evaluate a possible association between HHV-6 infection and acute leukemia in children and adults, with a longitudinal follow-up at diagnosis, aplasia, remission and relapse.MethodsHHV-6 load was quantified by a quantitative real-time PCR in the blood and bone marrow samples from 37 children and 36 adults with acute leukemia: 33 B acute lymphoblastic leukemia (B-ALL), 6 T acute lymphoblastic leukemia (T-ALL), 34 acute myeloid leukemia (AML).ResultsHHV-6 was detected in 15%, 8%, 30% and 28% of the blood samples at diagnosis, aplasia, remission and relapse, respectively. The median viral loads were 138, 244, 112 and 78 copies/million cells at diagnosis, aplasia, remission and relapse, respectively. In the bone marrow samples, HHV-6 was detected in 5%, 20% and 23% of the samples at diagnosis, remission and relapse, respectively. The median viral loads were 34, 109 and 32 copies/million cells at diagnosis, remission and relapse, respectively. According to the type of leukemia at diagnosis, HHV-6 was detected in 19% of the blood samples and in 7% of the bone marrow samples (with median viral loads at 206 and 79 copies/million cells, respectively) from patients with B-ALL. For patients with AML, HHV-6 was present in 8% of the blood samples and in 4% of the bone marrow samples (with median viral loads at 68 and 12 copies/million cells, respectively). HHV-6 was more prevalent in the blood samples from children than from adults (25% and 9%, respectively) and for the bone marrow (11% and 0%, respectively). All typable HHV-6 were HHV-6B species. No link was shown between neither the clinical symptoms nor the abnormal karyotype and HHV-6 activation. A case of HHV-6 chromosomal integration was shown in one patient with AML.ConclusionThis study confirms the absence of role of HHV-6 in the genesis of acute leukemia but the virus was reactivated after chemotherapy treatment.
The anticonvulsant hypersensitivity syndrome, also known as drug rash eosinophilia and systemic symptoms (DRESS), is a rare but severe form of adverse cutaneous reaction. Several aromatic anticonvulsant drugs, such as carbamazepine (CBZ), phenytoin, or phenobarbital have been frequently associated with the onset of DRESS. Cross-reactivity among the aromatic anticonvulsants frequently occurs (40 to 80% of patients). However, cross reactivity with other drugs such as betalactams have exceptionally been reported. We report a clinical observation describing a DRESS associated with CBZ with a subsequent hypersensitivity to amoxicillin (AMX). A 34-year-old male with a 20-year history of epilepsy was treated with valproic acid and phenobarbital. As he had frequent convulsive fits, CBZ was added. Thirty-four days later, the patient developed hyperthermia (39.5°C), cervical lymphadenopathy, and generalized cutaneous exfoliated maculae and papulae. Biochemical investigation was characterized by a white cell count of (16.1 × 103/μL, 17% eosinophils) and increased levels of aspartate aminotransferase and alanine aminotransferase (50 and 116 IU/L, respectively). CBZ was discontinued. One month later, all the symptoms were progressively relieved. Six weeks after complete recovery, prick and patch skin tests were performed. They were strongly positive at 48-hour reading. About 2 years later, the patient exhibited an extensive pruritic skin rash, 2 days after AMX intake. Laboratory exams showed eosinophilia (7%) but neither elevated liver enzymes nor renal dysfunction. All these symptoms have disappeared 5 days after AMX withdrawal. Intradermal test to AMX was positive but not to other betalactams. Throughout this clinical observation, we report a CBZ-induced DRESS and describe the possibility of cross reactivity between CBZ and AMX. This cross reactivity was observed despite the lack of chemical similarity between both drugs.
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