Eosinophilic esophagitis is a component of the anticonvulsant hypersensitivity syndrome: Description of two cases

Balatsinou, Chrysanthi; Milano, Angelo; Caldarella, M.P.; Laterza, Francesco; Pierdomenico, Sante D.; Cuccurullo, Franco; Neri, Matteo

doi:10.1016/j.dld.2007.01.017

Cited by 22 publications

(10 citation statements)

References 29 publications

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“…However, the mere presence of esophageal eosinophils is not specific for a particular disorder because eosinophil accumulation in the esophagus occurs in a variety of states including eosinophilic esophagitis (EE), eosinophilic gastroenteritis, gastroesophageal reflux disease (GERD), chronic (non eosinophilic) esophagitis (CE), parasitic and fungal infections, inflammatory bowel disease (IBD), hypereosinophilic syndrome (HES), scleroderma, drug and/or iatrogenic-induced states such as caustic injury, 2 multiple convulsive therapy syndrome 3 and immunosuppression especially following solid organ transplantation (Table 1). 4 As part of a spectrum of eosinophilic gastrointestinal disorders (EGID), it is notable that EE can evolve into and/or be associated with eosinophilic gastritis, enteritis and/or colitis.…”

Section: Clinical Entities Associated With Esophageal Eosinophiliamentioning

confidence: 99%

Biology and Treatment of Eosinophilic Esophagitis

2009

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Eosinophilic esophagitis, a recently recognized and growing clinical disorder over the past decade, is characterized by antigen-driven eosinophil accumulation in the esophagus. Symptoms frequently mimic those of gastroesophageal reflux disease (GERD) but the two diseases are quite distinct in terms of their histopathology, genetic signature, response to therapy, hereditary risk and association with allergy. Disease pathogenesis involves the interplay of external and genetic factors, particularly food antigens and the eosinophil chemoattractant eotaxin-3, respectively. Transcript signatures and animal models have uncovered the importance of adaptive T cell immunity involving IL-5 and IL-13 elicited esophageal epithelial cell responses. Notably, symptoms, dysregulated esophageal gene expression and pathology are largely reversible following reduction of specific food antigen exposure, as well as anti-inflammatory therapy, but chronic treatment is necessary to prevent relapse. As such, eosinophilic esophagitis is a disease with the unique features of chronic esophagitis, atopy, immune sensitization to oral antigens, reversibility and familial association.

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Section: Clinical Entities Associated With Esophageal Eosinophiliamentioning

confidence: 99%

Biology and Treatment of Eosinophilic Esophagitis

2009

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“…These autoimmune diseases can occur even several years after resolution of the DIHS. Complications are rare; they include limbic encephalitis, thyroid diseases, renal failure, syndrome of inappropriate secretion of antidiuretic hormone [25], spleen rupture [26], eosinophilic colitis [27], eosinophilic esophagitis [28], and myocarditis [29]. A recent report has described a case of lethal enterocolitis associated with CMV reactivations in the setting of DIHS [30].…”

Section: Case Presentationmentioning

confidence: 99%

Is the drug-induced hypersensitivity syndrome (DIHS) due to human herpesvirus 6 infection or to allergy-mediated viral reactivation? Report of a case and literature review

2010

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BackgroundDrug-Induced Hypersensitivity Syndrome (DIHS) is a severe and rare systemic reaction triggered by a drug (usually an antiepileptic drug). We present a case of DISH and we review studies on the clinical features and treatment of DIHS, and on its pathogenesis in which two elements (Herpesvirus infection and the drug) interact with the immune system to trigger such a syndrome that can lead to death in about 20% of cases.Case presentationWe report the case of a 26-year old woman with fever, systemic maculopapular rash, lymphadenopathy, hepatitis and eosinophilic leukocytosis. She had been treated with antibiotics that gave no benefit. She was taking escitalopram and lamotrigine for a bipolar disease 30 days before fever onset. Because the patient's general condition deteriorated, betamethasone and acyclovir were started. This treatment resulted in a mild improvement of symptoms. Steroids were rapidly tapered and this was followed with a relapse of fever and a worsening of laboratory parameters. Human herpesvirus 6 (HHV-6) DNA was positive as shown by PCR. Drug-Induced Hypersensitivity Syndrome (DIHS) was diagnosed. Symptoms regressed on prednisone (at a dose of 50 mg/die) that was tapered very slowly. The patient recovered completely.ConclusionsThe search for rare causes of fever led to complete resolution of a very difficult case. As DIHS is a rare disease the most relevant issue is to suspect and include it in differential diagnosis of fevers of unknown origin. Once diagnosed, the therapy is easy (steroidal administration) and often successful. However our case strongly confirms that attention should be paid on the steroidal tapering that should be very slow to avoid a relapse.

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“…Elemental dieting, absence of selected foods, and anti-allergy therapies result in clinical and histological remission (25). In addition, parallel esophageal and bronchial eosinophilic inflammation has been reported for some EE patients on a seasonal basis (26,27), as well as its development after food (28) or drug (29) ingestion. On all these grounds EE has been considered an immunoallergic disorder.…”

Section: Etiologymentioning

confidence: 99%

Eosinophilic esophagitis: clinical manifestations, diagnosis, and treatment

Lucendo

2009

Rev. esp. enferm. dig.

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Eosinophilic esophagitis is a component of the anticonvulsant hypersensitivity syndrome: Description of two cases

Cited by 22 publications

References 29 publications

Biology and Treatment of Eosinophilic Esophagitis

Biology and Treatment of Eosinophilic Esophagitis

Is the drug-induced hypersensitivity syndrome (DIHS) due to human herpesvirus 6 infection or to allergy-mediated viral reactivation? Report of a case and literature review

Eosinophilic esophagitis: clinical manifestations, diagnosis, and treatment

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