Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome

Tohyama, Mikiko; Hashimoto, Koji; Yasukawa, Masaki; Kimura, Hiroshi; Horikawa, Tsuyoshi; Nakajima, Kimiko; Urano, Yoshio; Matsumoto, K; Iijima, Masafumi; Shear, Neil H.

doi:10.1111/j.1365-2133.2007.08167.x

Cited by 299 publications

(243 citation statements)

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“…Reactivation of human herpesvirus (HHV), mainly HHV-6, and less frequently cytomegalovirus, has been described during the course of DIHS ⁄ DRESS. [5][6][7][8] These viral…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetics of cutaneous adverse drug reactions

Aihara

2011

The Journal of Dermatology

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Drug-induced hypersensitivity reactions are of major medical concern because they are associated with high morbidity and high mortality. In addition, individual patients' reactions are impossible to predict in each patient. In the field of severe cutaneous adverse drug reactions (cutaneous ADR) such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug-induced hypersensitivity syndrome (DHIS) or drug rash with eosinophilia and systemic symptoms (DRESS), major advances have recently been gained through studies of an association between HLA alleles and drug hypersensitivity induced by specific drugs. The results of these pharmacogenomic studies allow prediction of the risk of adverse reactions in patients treated with certain drugs, including carbamazepine and other aromatic antiepileptic drugs, allopurinol and abacavir. However, different ethnic populations show variations in the genetic associations. A strong association between carbamazepine-induced SJS ⁄ TEN and HLA-B*1502 has been found in Southeast Asian patients but not in Caucasian and Japanese patients. Moderate associations between aromatic amine anticonvulsants and other HLA alleles have been proposed in Japanese patients. In contrast, HLA-B*5801 was found to be associated with allopurinol-induced cutaneous ADR, including SJS ⁄ TEN and DIHS ⁄ DRESS, in Caucasian and Asian patients, including the Japanese. These differences may, at least in part, be due to the differences in allele frequency in different ethnic populations. This article reviews the progress in pharmacogenomics, associated mainly with carbamazepine and allopurinol in different ethnic populations. Pharmacogenetic screening based on associations between adverse reactions and specific HLA alleles helps to avoid serious conditions associated with drug hypersensitivity.

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“…Reactivation of human herpesvirus (HHV), mainly HHV-6, and less frequently cytomegalovirus, has been described during the course of DIHS ⁄ DRESS. [5][6][7][8] These viral…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetics of cutaneous adverse drug reactions

Aihara

2011

The Journal of Dermatology

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“…Ciddi ilaç reaksiyonu olan ancak İHSS kriterlerini sağlamayan bir grup hastada anti-HHV-IgG titresinde hiç artış saptanmaması, HHV-6 reaktivasyonunun İİHS'ye özel bir bulgu olduğunu düşündürmektedir 20 . Hastalarda HHV titresindeki artış ve pik düzeyine ulaşma ilaç reaksiyonunun başlangıcından 10-27 gün sonra tespit edilir 21 . Bu durum bizim hastamızda olduğu gibi tedavi altındaki hastalarda gelişen rekürrensleri açıklayabilir.…”

Section: Discussionunclassified

“…T hücre uyarımı, T hücrelerde muhafaza edilen herpes virüs viral genomunun reaktivasyonuna yol açar 22,23 . İİHS'li hastalarda görülen immünglobulin düşüklüğünün de HHV reaktivasyonuna katkıda bulunduğu düşünülmektedir 21 . İHSS gelişiminde genetik yatkınlık önemli rol oynamaktadır.…”

Section: Discussionunclassified

Sulfasalazin İle Tetiklenen İlaçla İlişkili Hipersensitivite Sendromu

Saral¹,

Akay²,

Şanlı³

2013

Turkderm

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Türk derm-De ri Has ta lık la rı ve Fren gi Ar şi vi Der gi si, Ga le nos Ya yı ne vi ta ra f›n dan ba s›l m›fl t›r. Turk derm-Arc hi ves of the Tur kish Der ma to logy and Ve ne ro logy, pub lis hed by Ga le nos Pub lis hing. Özetİlaçla ilişkili hipersensitivite sendromu (İİHS), ilaç reaksiyonları arasında en tehlikelilerinden biridir. Sistemik organ tutulumları bu reaksiyonun mortalite ve morbiditesini arttırmaktadır. Lezyonlar en sık makülopapüler döküntü şeklinde ortaya çıkmakla birlikte, lezyon morfolojisi farklılık gösterebilir. Çoğunlukla aromatik antikonvulzanlarla ortaya çıkar. Ancak başka ilaçların da bu ilaç reaksiyonu patogenezinde rol oynayabileceği unutulmamalıdır. Erken tanı tedavide en önemli basamaktır. Burada sulfasalazin ile tetiklenen ve klinik olarak makülopapüler döküntüye eşlik eden püstüler lezyonlarla prezente olan bir İİHS olgusu sunmaktayız. Sum maryDrug-induced hypersensitivity syndrome (DIHS) is one of the most dangerous drug reactions. Mortality and morbidity is increased by consequent systemic organ involvement. Maculopapular eruptions are the most common lesions accompanying DIHS, however, the morphology of skin lesions may vary. The most common cause of DIHS is the use of aromatic anticonvulsant drugs. However, one must not forget that other drugs may also cause DIHS. Early recognition of the condition is the most important step in the treatment. Herein, we present a case of DIHS triggered by sulphasalazine and associated with pustular eruption and maculopapular eruption. (Turkderm 2013; 47: 123-5)

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“…HHV-6, HHV-7, CMV and EBV can be the cause as well (2,7,(11)(12)(13)(14). HHV-6 reactivation is a diagnostic parameter (15). Therefore serology must be checked.…”

Section: Discussionmentioning

confidence: 99%

Diphenylhydantoin Induced DRESS Syndrome: A Case Report

Leblebici¹,

Soyal²,

Mutlu³

et al. 2014

Turk J Anesth Reanim

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Case Report 46Drug Rash with Eosinophilia and Systemic Symptoms" (DRESS) syndrome is a severe adverse drug reaction. The drugs most often implicated are anti-convulsants, bupropion, sulfonamides, sulfasalazine, allopurinol, minocycline, abacavir and neviparine. There are also immune and infectious causes that can lead to DRESS syndrome. A 70-year-old female patient had undergone endovascular coil embolization for intracranial aneurysm and experienced a generalised seizure postoperatively. She had been given diphenylhidantoin (DPH). Six days after DPH therapy, the patient had complained of widespread skin rash. Although DPH was replaced with levetiracetam afterwards, the skin rash deteriorated, causing facial oedema and swelling of the tongue. She had severe facial oedema with swelling of the tongue, causing disturbance of breathing. On the second day in the critical care unit, the patient's breathing deteriorated, leading successively to intubation and mechanical ventilation. The patient's rash was still persistent and the results of a punch biopsy taken from the lesions revealed superficial perivascular dermatitis involving spongiotic eosinophils compatible with spongiotic drug eruption. As a result, it is important to realise that medications we use can be the cause of a range of reactions ranging from simple rash to life threatening syndromes.Key Words: Drug reactions, dress syndrome, diphenylhidantoin AbstractOn physical examination at presentation, the patient had fever (38.8°C), diffuse erythema involving trunk and extremities, sparing palms of hands and feet, facial oedema and angioedema of the lips and tongue (Figures 1, 2). The laboratory findings on critical care arrival were as follows: WBC 17,000, PLT 335,000, Hb 10.5 gr dL -1 , Htc 33%, eosinophils 22.7%, total bilirubin 0.6 mmol, BUN 82 gr, creatinine 1.47 mg dL -1 and GFR 38 mL kg -1. The CBC revealed anisopoichilocytosis and eosinophilia. On the chest x-ray there was thickening of the middle and lower peribronchial zones of the lung parenchyma. Abdominal ultrasound showed minimal enlargement of the spleen and liver from the midclavicular line. Ursodeoxycholic acid therapy was started due to the potential for toxic hepatitis. In consensus with the dermatology department, the patient was given 80 mg day -1 prednisolone.On the second day of hospitalization in the critical care unit, the patient's breathing deteriorated, leading successively to intubation and mechanical ventilation. The patient's rash was still persistent and the results of the punch biopsy taken from the lesions revealed superficial perivascular dermatitis involving spongiotic eosinophils compatible with spongiotic drug eruption. Continuation of the prednisolone therapy until regression of the rash and cessation by reducing to a dosage of 10 mg week -1 was planned.On the third day of hospitalization, E. coli was detected in the urine culture and Ceftriaxone 2x1 gr was given accordingly.On the fifth day of hospitalization, the patient's skin lesions started to fade and, as her respir...

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Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome

Abstract: A combination of immunological reaction to a drug and HHV-6 reactivation results in the severe course of DIHS. The demonstration of HHV-6 reactivation is a useful marker of diagnosis as well as prognosis in DIHS.

Cited by 299 publications

References 28 publications

Pharmacogenetics of cutaneous adverse drug reactions

Pharmacogenetics of cutaneous adverse drug reactions

Sulfasalazin İle Tetiklenen İlaçla İlişkili Hipersensitivite Sendromu

Diphenylhydantoin Induced DRESS Syndrome: A Case Report

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