Reactivation of Human Herpesvirus (HHV) 6 as Etiology of Acute Liver Injury in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) syndrome: A Case Report

Li, Jonathan C.

doi:10.7759/cureus.29697

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Multi-organ system involvement have been reported with evidence of HHV-6 reactivation within specific organ parenchyma or in serum, sometimes leading to fatal sequelae related to the liver, 12 - 19 kidney, 7 , 12 , 20 - 23 gastrointestinal tract, 24 , 25 bone marrow, 12 , 26 - 28 lymph nodes, 12 , 29 , 30 peripheral and central nervous system, 7 , 31 - 34 heart, 13 , 35 and lung. 36 , 37 There have been many reports of new-onset autoimmune disease, as well.…”

Section: Resultsmentioning

confidence: 99%

“… 73 ciHHV-6 was ruled out in 3 patients, 24 , 57 , 82 but not in others with suspiciously high HHV-6 viral loads (5log 10 to 6log 10 copies/mL). 13 , 15 , 19 , 83 Thus, the true incidence of DRESS with ciHHV-6 may be underestimated. DRESS patients with high viral loads may benefit from ciHHV-6 testing to avoid misdiagnosis of HHV-6 reactivation and subsequent mistreatment.…”

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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“…Some authors suggest that HHV‐6 reactivation is unique to DRESS and not observed in other adverse cutaneous drug reactions 24 . Recently, a case of a 21‐year‐old patient diagnosed with DRESS syndrome was found to have the presence of HHV6 in both blood and biopsied liver tissue supporting viral hepatitis as the cause of liver injury in DRESS 25 . but the role of viral reactivation in DRESS is unclear so far.…”

Section: Discussionmentioning

confidence: 99%

Association of antiviral drugs and their possible mechanisms with DRESS syndrome using data mining algorithms

Sharma

Roy

Sharma

et al. 2023

Journal of Medical Virology

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Antiviral drugs are not known for drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. The current study aims is to find out the association of antiviral drugs and their possible mechanism with DRESS. Data mining algorithms such as proportional reporting ratio that is, PRR (≥2) with associated χ 2 value (>4), reporting odds ratio that is, ROR (≥2) with 95% confidence interval and case count (≥3) were calculated to identify a possible signal. Further, molecular docking studies were conducted to check the interaction of selected antiviral drugs with possible targets. The potential signal of DRESS was found to be associated with abacavir, acyclovir, ganciclovir, lamivudine, lopinavir, nevirapine, ribavirin, ritonavir, and zidovudine among all selected antiviral drugs. Further, subgroup analysis has also shown a potential signal in different age groups and gender. The sensitivity analysis results have shown a decrease in the strength of the signal, however, there was no significant impact on the outcome except for acyclovir. The docking results have indicated the possible involvement of human leukocyte antigen (HLA)*B1502 and HLA*B5801. The positive signal of DRESS was found with selected antiviral drugs except for acyclovir.antiviral drugs, data mining algorithms, docking study, DRESS | INTRODUCTIONVarious unexpected adverse drug reactions (ADRs) are observed in the postmarketing phase of drugs which are important for patient safety. Therefore, signal analysis plays an important role which is defined by World Health Organization (WHO) as "Reported information on a possible causal relationship between an adverse event and a drug, the relationship being previously unknown or incompletely documented. 1 Signals of disproportionate reporting (SDRs) are defined as the statistical association of drugs and ADRs which is also known as drug-event pairs. 2 Data mining algorithms (DMAs) such as proportionality reporting ratio (PRR) with associated χ 2 value, and reporting odds ratio (ROR) with 95% confidence interval are used to generate a hypothesis for SDRs using global databases such as Food and Drug Administration (FDA) adverse event reporting system (FAERS). 3,4 FAERS is a web-based tool for the public that contains human adverse events data reported to FDA by healthcare providers, consumers, and pharmaceutical industries. 5 OpenVigil is a tool used to extract clean data from the FAERS database. 6 Various classes of antiviral drugs such as nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and so forth are widely used in the treatment of various types of viral infections. 7 Most common ADRs associated with the use of these drugs are upset stomach, vomiting, diarrhea, and dizziness with antiherpes drugs (acyclovir, famciclovir, ganciclovir, etc.), headache, nausea, insomnia, bronchitis, hypersensitivity reactions with antiinfluenza virus drugs (oseltamivir, zanamivir, peramivir), pharyngitis, anemia, neutropenia,

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Clinical and virological problems of sudden exanthema in children

Grigorуev,

Kharitonova,

Nemtyreva

et al. 2024

Medsestra

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The problem of sudden exanthema/children’s roseola, an infection caused by HHV 6, is very relevant in our country. Domestic and foreign experts are actively studying the structure of the virus, the features of clinical forms and course options, methods for diagnosing infection, co-infection with other herpes viruses. It has been established that the immediate environment plays a leading role in the spread of infection. A review of recent data on sudden exanthema makes it clear why healthcare professionals retain such an unusual name for herpesvirus type 6 infection. The underdiagnosis of this disease in our country is associated with a lack of knowledge and alertness on the part of doctors and medical personnel. Although modern clinical and laboratory criteria for diagnosing HHV-6 infection make it possible to quite convincingly diagnose the disease with a fairly high degree of certainty. If desired. The advantage is the use of a technique for detecting virus DNA in plasma and other body media, in combination with serological research methods. The article presents modern recommendations for the treatment and prevention of sudden exanthema

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Reactivation of Human Herpesvirus (HHV) 6 as Etiology of Acute Liver Injury in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) syndrome: A Case Report

Cited by 3 publications

References 19 publications

Immunopathogenic Insights on Preferential Human Herpesvirus-6 Reactivation in Drug Rash With Eosinophilia and Systemic Symptoms: A Scoping Review

Immunopathogenic Insights on Preferential Human Herpesvirus-6 Reactivation in Drug Rash With Eosinophilia and Systemic Symptoms: A Scoping Review

Association of antiviral drugs and their possible mechanisms with DRESS syndrome using data mining algorithms

Clinical and virological problems of sudden exanthema in children

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