Drug-induced hypersensitivity syndrome with human herpesvirus-6 reactivation.
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| Abstract |
A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.
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| Authors | Najeeba Riyaz, S Sarita, G Arunkumar, S Sabeena, Neeraj Manikoth, C P Sivakumar |
| Journal | Indian journal of dermatology, venereology and leprology (Indian J Dermatol Venereol Leprol) 2012 Mar-Apr Vol. 78 Issue 2 Pg. 175-7 ISSN: 0973-3922 [Electronic] United States |
| PMID | 22421649 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't) |
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