Herpes Zoster in Patients with Drug-induced Hypersensitivity Syndrome/DRESS

Kano, Yoko; Horie, Chiho; Inaoka, Miyuki; Ishida, Tadashi; Mizukawa, Yoshiko; Shiohara, Tetsuo

doi:10.2340/00015555-1317

Cited by 14 publications

(14 citation statements)

References 14 publications

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“…There have only been 3 reports on herpes zoster in the course of DIHS (13). Kano et al (13) suggested that the reduction or withdrawal of corticosteroid in the setting of DIHS could contribute to the development of herpes zoster. However, there has been no report of varicella as a DIHS complication.…”

Section: Discussionmentioning

confidence: 99%

Drug-induced Hypersensitivity Syndrome in Association with Varicella

Tsutsumi¹,

Adachi²,

Yoshida³

et al. 2015

Acta Derm Venerol

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Drug-induced hypersensitivity syndrome (DIHS) is a severe multiorgan reaction related to the reactivation of human herpesvirus (HHV)-6 (1). Recently, the involvement of other types of HHV, including herpes simplex virus (HSV), Epstein-Barr virus (EBV), HHV-7, and cytomegalovirus (CMV), has been reported (2-5). We report here the first case of DIHS possibly associated with reactivation of varicella-zoster virus (VZV). CASE REPORTA 72-year-old woman was referred to our clinic because of skin eruptions covering almost her entire body. About 4 weeks before, she had taken salazosulphapyridine, bucillamine, and prednisolone (PSL) for treatment of rheumatoid arthritis. However, she stopped taking the drugs one week before referral due to vomiting and diarrhoea. She had a slight fever and generalised skin lesions for 3 more days. She was first hospitalised in the local hospital with a primary diagnosis of drug eruption. Thirty mg/day of PSL was administrated intravenously on the first day of hospitalisation. However, there was no improvement in symptoms and she was referred to our clinic. Her vitals on admission were as follows: temperature of 37.2ºC and blood pressure of 185/82 mmHg. Physical examination revealed infiltrative erythematous macules and papules on the entire body and facial oedema (Fig. 1a). There was no lymphadenopathy. Laboratory data were as follows: white blood cell (WBC) count of 11,200 /mm 3 with 65% neutrophils, 23% lymphocytes, 4% eosinophils, 0% monocytes and C-reactive protein of 3.2 mg/dl (normal < 0.20 mg/dl). Liver and renal functions were within normal limits.A skin biopsy specimen obtained from the left thigh revealed focal spongiosis and basal vacuolar change with lymphocyte exocytosis in the epidermis and superficial perivascular lymphocytic infiltration in the dermis. We suspected drug eruption including a possibility of DIHS because of the prescription of salazosulphapyridine. We prescribed 60 mg/day of oral PSL. We consulted the department of internal medicine regarding gastrointestinal symptoms. She was diagnosed with acute colitis associated with drug eruption and was recommended treatment with antiflatulent and no fasting temporarily. Since the skin lesions and fever were improved, we gradually tapered the daily dose of PSL and terminated administration after 15 days.However, on the 17 th day after onset of the first rash, she developed erythemas and papules on the abdomen again with high fever of 38.0ºC and she showed abnormal values in liver function tests: aspartate aminotransferase (AST) level, 70 IU/l (normal 13-33 IU/l); alanine aminotransferase (ALT) level, 280 IU/l (normal 8-42 IU/l); gamma-glutamyltransferase (γ-GT) level, 66 IU/l (normal 10-47 IU/l); lactate dehydrogenase (LDH) level, 329 IU/l (normal 119-229 IU/l). Ten days later, though WBC count was normalised to 5,500/μl, eosinophilia of 22% occurred. A second skin biopsy from the patient's abdomen revealed marked spongiosis with lymphocyte exocytosis, extravasated erythrocytes in the epidermis and severe basal vacuola...

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Section: Discussionmentioning

confidence: 99%

Drug-induced Hypersensitivity Syndrome in Association with Varicella

Tsutsumi¹,

Adachi²,

Yoshida³

et al. 2015

Acta Derm Venerol

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“…Systemic corticosteroids may contribute to this risk, and like immune restoration syndrome, withdrawal of corticosteroid may trigger HZ [275]. …”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

et al. 2017

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BackgroundHerpes zoster (HZ) is a prevalent viral disease that inflicts substantial morbidity and associated healthcare and socioeconomic burdens. Current treatments are not fully effective, especially among the most vulnerable patients. Although widely recommended, vaccination against HZ is not routine; barriers in Asia-Pacific include long-standing neglect of adult immunisation and sparse local data. To address knowledge gaps, raise awareness, and disseminate best practice, we reviewed recent data and guidelines on HZ from the Asia-Pacific region.MethodsWe searched PubMed, Scopus, and World Health Organization databases for articles about HZ published from 1994 to 2014 by authors from Australia, China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand, and Vietnam. We selected articles about epidemiology, burden, complications, comorbidities, management, prevention, and recommendations/guidelines. Internet searches retrieved additional HZ immunisation guidelines.ResultsFrom 4007 retrieved articles, we screened-out 1501 duplicates and excluded 1264 extraneous articles, leaving 1242 unique articles. We found guidelines on adult immunisation from Australia, India, Indonesia, Malaysia, New Zealand, the Philippines, South Korea, and Thailand.HZ epidemiology in Asia-Pacific is similar to elsewhere; incidence rises with age and peaks at around 70 years – lifetime risk is approximately one-third. Average incidence of 3–10/1000 person-years is rising at around 5% per year. The principal risk factors are immunosenescence and immunosuppression. HZ almost always causes pain, and post-herpetic neuralgia is its most common complication. Half or more of hospitalised HZ patients have post-herpetic neuralgia, secondary infections, or inflammatory sequelae that are occasionally fatal. These disease burdens severely diminish patients’ quality of life and incur heavy healthcare utilisation.ConclusionsSeveral countries have abundant data on HZ, but others, especially in South-East Asia, very few. However, Asia-Pacific countries generally lack data on HZ vaccine safety, efficacy and cost-effectiveness. Physicians treating HZ and its complications in Asia-Pacific face familiar challenges but, with a vast aged population, Asia bears a unique and growing burden of disease. Given the strong rationale for prevention, most adult immunisation guidelines include HZ vaccine, yet it remains underused. We urge all stakeholders to give higher priority to adult immunisation in general and HZ in particular.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2198-y) contains supplementary material, which is available to authorized users.

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“…Reactivation of VZV, which appears as recurrent varicella or herpes zoster, might be overlooked due to very mild symptoms in some cases. Kano et al also stated that significant increases in anti-VZV IgG antibody titers were detected in 2 of their 11 patients with DIHS/ DRESS who had no clinical symptoms as unpublished observations [9]. Thus, reactivation of VZV could occur in the early phase and long after the onset of DIHS, as seen in bone marrow transplantation cases with a latency period ranging from days to several years after the transplantation procedure.…”

Section: Discussionmentioning

confidence: 92%

“…In contrast to our patient, the previously reported case showed reactivation of HHV-6, but, like our patient, experienced early recurrence of varicella (on the 17 th day of illness) with mild clinical symptoms. Herpes zoster, another form of reactivation of VZV, was also reportedly observed 2-5 months after developing DIHS as an immune reconstitution syndrome when PSL was tapered or discontinued [9]; this occurred 3 years after the onset in one patient [2]. Similarly, herpes zoster described in association with DIHS also showed mild cutaneous manifestations without complications.…”

Section: Discussionmentioning

confidence: 99%

A Case of Drug-Induced Hypersensitivity Syndrome with Recurrent Varicella

Shimura¹,

Ueno²,

K³

et al. 2017

J Clin Exp Dermatol Res

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Drug-induced hypersensitivity syndrome (DIHS) is attributed to immunodeficiency caused by certain drugs. Herein, we report a patient with DIHS due to recurrent varicella caused by reactivation of the varicella-zoster virus (VZV). The patient was a 39-year-old woman, who had started oral carbamazepine treatment for trigeminal neuralgia eight weeks before developing a high-grade fever and dark red plaques appearing over the entire body. She was diagnosed as having DIHS with liver dysfunction, atypical lymphocytes in peripheral blood, and lymphadenopathy. Oral administration of prednisolone at 50 mg/day was started and then tapered to 40 mg/day 13 days after the onset. Vesicles and blisters with bleeding in part subsequently appeared sporadically on the trunk and limbs. At that time, anti-VZV-IgM and VZV IgG antibody titers exceeded the normal ranges, and the patient was thus considered to have recurrent varicella. Mild symptoms including scattered blisters disappeared without treatment. This case suggested that VZV is one of the earliest viruses to reactivate in the development of DIHS.

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Herpes Zoster in Patients with Drug-induced Hypersensitivity Syndrome/DRESS

Cited by 14 publications

References 14 publications

Drug-induced Hypersensitivity Syndrome in Association with Varicella

Drug-induced Hypersensitivity Syndrome in Association with Varicella

Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific

A Case of Drug-Induced Hypersensitivity Syndrome with Recurrent Varicella

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