Nevus anemicus: An island of sparing in the setting of drug-induced hypersensitivity

López, Ana M.; Rotemberg, Veronica; Husain, Sameera; Schneiderman, Paul I.; Geskin, Larisa J.

doi:10.1016/j.jdcr.2018.03.012

Cited by 3 publications

(3 citation statements)

References 14 publications

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“… 8 , 11 , 44 , 46 - 50 While there are many reports of delayed seroconversion or reactivation, 9 , 15 , 33 , 37 , 51 - 54 sometimes with initially undetectable viral loads, 21 , 27 , 55 , 56 HHV-6 reactivation at the onset of DRESS is possible, as well. 8 , 28 , 32 , 57 , 58 It should be noted that HHV-6 reactivation has not been reported before DRESS onset, which suggests that HHV-6 reactivation likely does not cause DRESS. However, it is possible that reactivation exacerbates downstream sequelae.…”

Section: Resultsmentioning

confidence: 99%

“… 15 , 17 , 18 , 20 , 31 , 36 , 56 , 75 Complete resolution of DRESS has been reported in transplant patients on systemic steroids, who were given ganciclovir or valganciclovir. 58 , 75 Kim et al successfully treated a steroid-refractory case with tofacitinib, a Janus kinase inhibitor, and valganciclovir. 63 Additionally, agents with anti-HHV-6 activity have reduced drug-induced T-cell proliferation in a dose-dependent manner.…”

Section: Resultsmentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

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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“…However, such patients have demonstrated complete resolution of DRESS with ganciclovir monotherapy. 10,11 Currently, there are no formal trials assessing the efficacy and safety of ganciclovir in DRESS. We advocate for greater study of the role of HHV-6 antivirals in DRESS, especially in HHV-6-associated cases refractory to discontinuation of the offending medication and initiation of high-dose corticosteroids.…”

mentioning

confidence: 99%