Case 26-2018: A 48-Year-Old Man with Fever, Chills, Myalgias, and Rash

Turbett, Sarah E; Tsiaras, William G.; McDermott, Shaunagh; Eng, George

doi:10.1056/nejmcpc1807494

Cited by 1 publication

(1 citation statement)

References 17 publications

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“…Only 1 DRESS patient with ciHHV-6, who unsurprisingly exhibited HHV-6 viremia throughout the entire clinical course, has been reported. 73 ciHHV-6 was ruled out in 3 patients, 24 , 57 , 82 but not in others with suspiciously high HHV-6 viral loads (5log 10 to 6log 10 copies/mL). 13 , 15 , 19 , 83 Thus, the true incidence of DRESS with ciHHV-6 may be underestimated.…”

Section: Resultsmentioning

confidence: 99%

Immunopathogenic Insights on Preferential Human Herpesvirus-6 Reactivation in Drug Rash With Eosinophilia and Systemic Symptoms: A Scoping Review

Zhu

Ren

2023

J Cutan Med Surg

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Introduction Human herpesvirus-6 (HHV-6) is a ubiquitous lymphotropic betaherpesvirus that can reactivate in drug rash with eosinophilia and systemic symptoms (DRESS). Despite recent publications advancing our understanding of HHV-6 in DRESS, the exact role of HHV-6 in disease pathogenesis remains unclear. Methods A scoping review with the PubMed query “(HHV 6 AND (drug OR DRESS OR DIHS)) OR (HHV6 AND (drug OR DRESS OR DIHS))” was conducted in accordance with PRISMA guidelines. Articles containing original data on at least one DRESS patient with HHV-6 testing were included. Results Our search returned a total of 373 publications, of which 89 met eligibility criteria. HHV-6 reactivation occurred in 63% of DRESS patients (n = 748), which was significantly more often than other herpesviruses. HHV-6 reactivation was associated with worse outcomes and greater severity in controlled studies. Case reports have demonstrated sometimes fatal HHV-6-related multi-organ involvement. Temporally, HHV-6 reactivation typically occurs 2 to 4 weeks after DRESS onset and has been linked to markers of immunologic signaling, such as OX40 (CD134), an HHV-6 entry receptor. Efficacy of antiviral or immunoglobulin treatment has only been demonstrated anecdotally, and steroid use may affect HHV-6 reactivation. Conclusion HHV-6 is implicated in DRESS more than in any other dermatologic condition. It is still unclear whether HHV-6 reactivation is cause or consequence of DRESS dysregulation. Similar pathogenic mechanisms precipitated by HHV-6 in other contexts may be relevant in DRESS. Future randomized controlled studies to assess effects of viral suppression on clinical outcomes is needed.

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