Our computational results suggest that dapsone would fit within the structure of the antigen-recognition site of HLA-B*13:01. This may change the self-peptides that bind to HLA-B*13:01, explaining why HLA-B*13:01 is a marker of DHS susceptibility.

Drug‐induced hypersensitivity syndrome (DIHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a multi‐organ systemic drug reaction characterized by hematological abnormalities and reactivation of human herpesvirus‐6 (HHV‐6). DIHS/DRESS is typically associated with a limited number of drugs, such as the anticonvulsants. Our group has treated 12 patients for DIHS/DRESS due to lamotrigine (LTG), but their presentation differed from that of patients with DIHS/DRESS caused by other drugs. The aim of the present study was to identify significant differences between DIHS/DRESS caused by LTG versus other drugs. We retrospectively reviewed data of 12 patients with DIHS/DRESS caused by LTG and 32 patients with DIHS/DRESS due to other drugs. The increase in alanine aminotransferase level was significantly milder in the LTG group than the DIHS/DRESS group due to other drugs. The percentage of atypical lymphocytes in the blood during DIHS/DRESS was lower in the LTG group. Serum levels of lactate dehydrogenase and thymus and activation‐regulated chemokine were also lower in the LTG group. There were fewer DIHS/DRESS patients with HHV‐6 reactivation in the LTG group than in the group treated with other drugs. Lymphocyte transformation after DIHS/DRESS onset was faster in the LTG group. The two groups did not differ with respect to the interval from first drug intake to rash, white blood cell count, blood eosinophilia or DRESS score. There were no significant histopathological differences between the two groups. The features of LTG‐associated DIHS/DRESS and DIHS/DRESS due to other drugs differ.

Predictive and diagnostic biomarkers for non-HIV immune reconstitution inflammatory syndrome (IRIS) associated with drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) have not been established. 1 Candidate cytokines/chemokines and blood cell counts were analyzed in a typical case of DIHS/DRESS with multiple virus reactivations and autoimmune IRIS.A 41-year-old woman presented with a generalized rash and high fever. Carbamazepine at 200-400 mg/day had been prescribed for trigeminal neuralgia. A disseminated maculopapular rash appeared at 26 days after starting the carbamazepine, and the rash spread to the entire body. Carbamazepine was discontinued on day 13 of illness.Laboratory findings on admission included the following: white blood cell count 33 400/μl (normal 3000-9000/μl), direct eosinophil count 1850/μl (normal <100 μl), platelets 14.0 × 10 4 /μl (normal 15.0-40.0/ μl), AST 287 U/L (normal 13-30 U/L), ALT 419 U/L (normal 7-23 U/L), creatinine 1.49 mg/dl (normal 0.50-0.90 mg/dl), CRP 9.75 mg/dl (normal <0.02 mg/dl), and thymus and activation-regulated chemokine 15540 pg/ml (normal <450 pg/ml). Histopathology revealed interface dermatitis with mild eosinophilia. Systemic steroidal therapy of 100 mg/day soluble prednisolone was started on day 14 of illness. Medicine