A Case of Drug-Induced Hypersensitivity Syndrome with Recurrent Varicella

Abstract

Drug-induced hypersensitivity syndrome (DIHS) is attributed to immunodeficiency caused by certain drugs. Herein, we report a patient with DIHS due to recurrent varicella caused by reactivation of the varicella-zoster virus (VZV). The patient was a 39-year-old woman, who had started oral carbamazepine treatment for trigeminal neuralgia eight weeks before developing a high-grade fever and dark red plaques appearing over the entire body. She was diagnosed as having DIHS with liver dysfunction, atypical lymphocytes in peripheral blood, and lymphadenopathy. Oral administration of prednisolone at 50 mg/day was started and then tapered to 40 mg/day 13 days after the onset. Vesicles and blisters with bleeding in part subsequently appeared sporadically on the trunk and limbs. At that time, anti-VZV-IgM and VZV IgG antibody titers exceeded the normal ranges, and the patient was thus considered to have recurrent varicella. Mild symptoms including scattered blisters disappeared without treatment. This case suggested that VZV is one of the earliest viruses to reactivate in the development of DIHS.