Human herpesvirus 6 infection associated with anticonvulsant hypersensitivity syndrome and reactive haemophagocytic syndrome

Abstract

Viral infections are thought to play a part in some cutaneous drug reactions. Human herpesvirus 6 (HHV6), which is the agent of exanthema subitum (sixth disease), has never been implicated in a drug reaction. We report a patient with severe phenobarbital-induced anticonvulsant hypersensitivity syndrome in whom a fulminant haemophagocytic syndrome was associated with HHV6 infection. We discuss the possible role of HHV6 in this reactive condition.

Human Herpesvirus 6 Reactivation in Trichloroethylene‐exposed Workers Suffering from Generalized Skin Disorders Accompanied by Hepatic Dysfunction

“…Of these reactions, HHV-6 reactivation in adults has been reported in druginduced HS [19][20][21][22][23][24] . However, in the present study, anti-HHV-6 titers increased also in some female patients suffering from diseases of erythema multiforme spectrum.…”

“…This is the first report showing that human herpesvirus 6 (HHV-6), the causative virus of exanthema subitum [16][17][18] , the reactivation of which has been reported in patients with drug-induced HS [19][20][21][22][23][24] , can also be reactivated in those having developed skin disorders after occupational solvent exposure.…”

Severe graft failure presumably due to phenytoin-induced hypersensitivity syndrome in two patients after bone marrow transplantation

“…It is unclear, however, whether there is a pathogenic role for viral infections in DIHS or whether infections are secondary to immune dysfunction. 5,6 Interestingly, there seems to be a genetic disposition as siblings of affected patients have up to 25% risk of developing a similar reaction after exposure to the same drug. 7,8 Significance of different ethnic backgrounds is uncertain, as a slightly higher incidence in persons of African descent may be attributed to more frequent indication for use of antiepileptics in this population.…”

Skin manifestations of drug allergy

“…Published case reports and small series have pointed to oral prednisolone to treat DRESS as probably the most accepted intervention in the treatment of severe drug reactions: 1-1.5 mg kg -1 has been recommended but we have seen efficacious responses to 0.5 mg kg -1 (unpublished) with rapid resolution of rash and fever. The association with human-herpes virus-6 (HHV-6) re-activation characteristically 2 weeks after rash onset, was recognized in the late 1990s [32,54,55] and has been proposed as an explanation for the characteristic flaring seen in this condition [56] although precise explanation of the role of the virus in the disease remains unclear. Careful monitoring for potential viral reactivation is therefore essential, but it should be noted that sporadic reports have identified reactivation of other herpes viruses as well (EBV, CMV, HHV-6, HHV-7, HSV, VZV) [31].…”