Valacyclovir-induced drug reaction with eosinophilia and systemic symptoms

Kitayama, Shohei; Makino, Teruhiko; Kataoka, K.; Mori, Shuichi; Furukawa, Fumina; Torai, Ryotaro; Mizawa, Megumi; Shimizu, Tadamichi

doi:10.1684/ejd.2022.4283

Cited by 2 publications

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“… 4 One drug that shares the chemical structure of a 2‐aminopurine nucleus with ganciclovir is the anti‐herpesvirus drug valacyclovir, and four cases of DRESS due to this drug have been reported. 5 , 6 Vernassiere et al. also suggested that ganciclovir and valacyclovir may represent a common drug allergy because of their shared chemical structure.…”

Section: Casementioning

confidence: 99%

“…Regarding the allergological work‐up, drugs such as ganciclovir may be overlooked in patients taking various drugs because of their low imputability. 6 Ganciclovir is often used for patients in highly immunosuppressed states (e.g., after haematopoietic stem cell transplantation or during immunosuppressive therapy). In these situations, a patch test and delayed intradermal testing, a common method for identifying the cause of SCARs, may yield false‐negative results.…”

Section: Casementioning

confidence: 99%

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Ganciclovir‐induced drug reaction with eosinophilia and systemic symptoms

Kitayama

Makino

Fujita

et al. 2023

Skin Health and Disease

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse reaction involving multiorgan failure, with a complex interaction of various drugs, human herpesvirus reactivation and immune abnormalities suggested as the aetiology. We herein present the case of a 70‐year‐old man with a one‐week history of fever, facial oedema, erythematous macules and purpura on his trunk and extremities. He had anti‐TIF1γ antibody‐positive dermatomyositis and was treated with prednisolone sodium succinate (20 mg/day). Three weeks earlier, he was treated with ganciclovir (250 mg/day) for 7 days to treat asymptomatic cytomegalovirus viraemia. Laboratory investigations revealed eosinophilia with atypical lymphocytes and elevated liver enzyme levels. A histological examination showed interface dermatitis with necrotic keratinocytes, perivascular infiltration of lymphocytes and eosinophils in the upper dermis and erythrocyte extravasation without vasculitis. A lymphocyte transformation test (LTT) was positive for ganciclovir (stimulation index: 260%; normal: <180%). We diagnosed DRESS caused by ganciclovir on the basis of clinical findings and course (Definite; RegiSCAR score: 7). He was treated with prednisolone sodium succinate (40 mg/day) and topical clobetasol propionate (0.05%) ointment twice daily. After the initiation of treatment, the skin lesions and laboratory abnormalities gradually improved. To our knowledge, this is the first case of DRESS caused by ganciclovir. The patients in whom ganciclovir is used are often immunosuppressed and may be overlooked as the causative drug for DRESS by conventional skin tests. We considered that LTT is useful for identifying causative drugs of DRESS, especially in immunosuppressed patients, such as the present case.

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Section: Casementioning

confidence: 99%

Section: Casementioning

confidence: 99%