Allopurinol Hypersensitivity Syndrome Associated with Systemic Cytomegalovirus Infection and Systemic Bacteremia.

Abstract

A 43-year-old man developed fever, skin rash, eosinophillia, and severe renal and liver dysfunction following treatment with allopurinol. The patient died after 3 months of hospitalization. Autopsy revealed systemic cytomegalovirus infection and bacteremia. (Internal Medicine 40: 331-335, 2001)

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease

“…Early or late scores $4 were associated with the later development of CMV disease and complications (Table III). Receiver operator characteristic curves confirmed that this composite score had the Arrhythmia (1), brain tumor (2), bullous disease (1), cerebrovascular disease (1), dementia (1), epilepsy (2), GuillaineBarre syndrome (1), and hyperuricemia (3) Brain tumor (1), cerebrovascular disease (2), epilepsy (12), fibromyalgia (1), hyperuricemia (7), neuralgia (3), psychological illness (17), and restless legs syndrome (1) Causative drug (n)…”

“…Complications occurring during DiHS/DRESS have been extensively described in previous studies [5][6][7][8][9][10][11][12][13][14] and have received attention as the cause of mortality in DiHS/DRESS. These complications include myocarditis, Pneumocystis jirovecii pneumonia, sepsis, and gastrointestinal bleeding, 5-14 most of which lead to significant morbidity and mortality if unrecognized and untreated.…”

“…These complications include myocarditis, Pneumocystis jirovecii pneumonia, sepsis, and gastrointestinal bleeding, 5-14 most of which lead to significant morbidity and mortality if unrecognized and untreated. [5][6][7]10,12,13 Therefore, the establishment of a scoring system using routinely obtained parameters by which disease severity and treatment efficacy can be assessed at any time and disease progression to more aggressive stage can be predicted is urgently needed for the successful management of DiHS/DRESS. By comparing the composite score in the early phase (days 0-3) with that at any time after starting therapy, the composite score can provide clinicians with clues for optimizing therapeutic efficacy and preventing treatmentrelated relapse.…”

“…Various clinical symptoms and fatal complications that have traditionally been regarded as being either related or unrelated to severe drug eruptions or CMV reactivation may develop at various time points after onset, indicating difficulties to predict its prognosis. [1][2][3]6 Because these complications have been underrecognized and are often fatal if not promptly treated, [5][6][7][8][9][10][11][12][13][14][15] there is a clear need to identify effective parameters for assessing disease severity and predicting prognosis of the disease in the early stage.…”

Reactivation of human herpesvirus (HHV) family members other than HHV-6 in drug-induced hypersensitivity syndrome

“…Recent reports have suggested that reactivation of other members of the herpesvirus family, including HHV‐7, 1,10,11 CMV 4,6 and EBV, 3 may also be involved in the pathomechanisms of DIHS. Furthermore, multiple viral reactivation 11,12 and sequential viral reactivation 10,13 have been reported in some cases of DIHS. In the present study, multiviral reactivation was observed in all seven patients: HHV‐6, HHV‐7, CMV and EBV were reactivated in one patient; HHV‐6, HHV‐7 and CMV in four patients; HHV‐6, CMV and EBV in one patient; and HHV‐6 and CMV in one patient.…”