Detection of cytomegalovirus in the gastric ulcer of a patient with drug-induced hypersensitivity syndrome

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

“…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.…”

“…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.…”

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

“…A typical feature of DIHS/DRESS is the reactivation of latent HHVs, namely HHV-6, HHV-7, Epstein–Barr virus (EBV), and Cytomegalovirus (CMV) [ 22 , 49 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ]. Herpes viruses are known to promote the reactivation of other viruses upon reactivating themselves with a peculiar reactivation sequency, as originally reported by Kano 2006 [ 63 ] and recently reviewed by Anci 2021 [ 58 ].…”

“…Few reports of complications due to reactivation of HSV or VZV in DIHS/DRESS have been published [ 81 , 82 ]. By contrast CMV reactivation can induce some of the late-onset complications of DIHS/DRESS [ 49 , 59 , 83 ], which can present up to two months after the onset of DIHS/DRESS and even culminate with death. This occurs especially in the case of evident CMV disease, whose manifestations can be hepatitis, pneumonia, gastroenteritis, and skin and gastrointestinal ulcers.…”

“…Gastrointestinal haemorrhage caused by CMV has an unpredictable course and may frequently result in death. For this reason, early detection of CMV reactivation is necessary for successful management of DIHS/DRESS patients, and early administration of anti-CMV treatment can keep these patients from developing acute symptoms [ 56 , 59 ]. A case of esophagitis in DRESS syndrome also has been described [ 197 ].…”