Influence of corticosteroid therapy on viral reactivation in drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms

Abstract

Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characteristically associated with sequential reactivation of herpesviruses, such as human herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Since systemic corticosteroids are thought to result in viral reactivation due to their immunosuppressive effects, we clarified the influence of systemic corticosteroid therapy on viral reactivation in DIHS/DRESS. Viral DNA in peripheral whole blood and serum sIL-2R level were measured during the disease course in twenty DIHS/DRESS patients. Six of seven patients treated without corticosteroids experienced HHV-6 viremia associated with elevated serum sIL-2R levels. In contrast, high-dose corticosteroids started within 1 week after onset tended to inhibit the occurrence of HHV-6 reactivation with remarkable suppression of serum sIL-2R level. Low-dose corticosteroids or late-start high-dose corticosteroids did not suppress occurrence of HHV-6 viremia and the increase of sIL-2R levels. HHV-6 load in the blood was clearly correlated with the serum sIL-2R level. On the other hand, increased CMV load were found in patients treated with corticosteroids regardless of the start time. The frequency of detection of EBV DNA in peripheral blood was similarly observed in all groups. In conclusion, high-dose corticosteroids started within 1 week tended to suppress HHV-6 reactivation through suppression of T cell activation. However, CMV proliferation was promoted by corticosteroids regardless of the start time. These observations suggested that careful consideration should be given to the dose and timing of administration of systemic corticosteroids in the treatment of DIHS/DRESS.

Degos‐like lesions as a cutaneous manifestation of cytomegalovirus infection: A rare and serious complication in a patient with drug‐induced hypersensitivity syndrome

“…An inappropriate cell‐mediated immunity is responsible for the sequential reactivation of herpesviruses in DIHS 5 . Furthermore, immunosuppressive effects of high‐dose corticosteroid therapy predispose patients to CMV reactivation 15 . Interestingly, a recent review proposed that CMV reactivation in patients with DIHS is one of the manifestations in immune reconstitution inflammatory syndrome, usually occurring during the period of corticosteroid reduction 5 .…”

A case of hypereosinophilia with digital ischaemia successfully treated with intravenous prostaglandin E1

“…His pre-existing condition such as bronchial asthma and eosinophilic chronic sinusitis strongly indicated the case as HES. 5 However, based on non-specific signals of anti-human herpes viruses 6 (HHV-6) antibody in his blood sample, we could not clearly rule out drug-induced hypersensitivity syndrome which is characteristically associated with reactivation of HHV-6. We diagnosed the case as erythroderma with secondary HE caused by chronic drug eruption, or HES.…”

“…Skin biopsy taken from the waist showed infiltration of lymphocytes and eosinophils (Figure 1h). His pre‐existing condition such as bronchial asthma and eosinophilic chronic sinusitis strongly indicated the case as HES 5 . However, based on non‐specific signals of anti‐human herpes viruses 6 (HHV‐6) antibody in his blood sample, we could not clearly rule out drug‐induced hypersensitivity syndrome which is characteristically associated with reactivation of HHV‐6.…”

DRESS syndrome on the background of adding meropenem to carbamazepine therapy: a clinical case

“…Однако M. Tohyama и соавт. показали, что реактивация ВПГ-6 происходила чаще у пациентов, не получавших стероиды, по сравнению с группами, получавшими высокие дозы стероидов [21].…”