Drug-induced
hypersensitivity syndrome (DIHS), characterized by serious adverse systemic reactions in addition to
skin rash, has unknown pathogenesis. Its association with human herpesvirus (HHV), mainly HHV-6, has been reported recently. A 46-year-old Japanese man is described in whom a generalized eruption developed about 1 month after taking
cyanamide, a
drug for
alcoholism. This was associated with the following manifestations: high
fever,
lymphadenopathy, facial
edema, marked
leukocytosis with
eosinophilia and atypical lymphocytes,
lymphocytopenia, liver and renal dysfunction, and low
IgG level. He was treated with 8 mg
betamethasone daily and his condition improved, but he needed low-dose
corticosteroid for almost 1 year because of several episodes of recurrence. HHV-6, HHV-7, herpes simplex virus (HSV), and cytomegalovirus (CMV) specific
IgG titers showed more than a four-fold rise sequentially. Significant numbers of copies of HHV-6 and HHV-7
DNA were detected in the peripheral white blood cells by real-time polymerase chain reaction (PCR). HHV-6 and CMV
DNA were detected in the serum by nested PCR. A patch test for
cyanamide was positive. The diagnosis of DIHS due to
cyanamide, which has never been reported as a causal
drug of DIHS, accompanied by reactivation of not only HHV-6, but also HHV-7, CMV, and HSV, was made. Disturbance of the immune system was suggested by the persistent low level of
IgG, and consecutive viral reactivation may have participated in the prolonged course in this case.