New aspects of drug‐induced hypersensitivity syndrome

Abstract

Drug-induced hypersensitivity syndrome (DIHS) is caused by a limited number of specific drugs and is characterized by late onset, infectious mononucleosis-like symptoms, and herpesvirus 6 (HHV-6) reactivation. Recently, the involvement of herpes viruses other than HHV-6, such as Epstein-Barr virus and cytomegalovirus, has been reported. Many approaches have been used to analyze the pathological mechanism, and have revealed new aspects of DIHS. Here, we focused on three key recent findings regarding DIHS: (i) overlap between DIHS and Stevens-Johnson syndrome ⁄ toxic epidermal necrolysis; (ii) the relevance of Epstein-Barr virus in the development of infectious mononucleosis-like symptoms of DIHS; and (iii) roles of monomyeloid precursors increased in the blood and plasmacytoid dendritic cells increased in the lesion skin in HHV-6 reactivation.

A Sulphasalazine-Induced Hypersensitivity Syndrome Mimicking Viral Rash Illness

“…Sınırlı sayıda ilaçla ortaya çıkması, geç başlangıçlı olması, uzamış seyri ve mononükleozisi andıran bulguları nedeniyle DRESS adı verilen ilaç reaksiyonlarından ayrılır (6). İHSS, DRESS'den daha ciddi olguları içeren formdur.…”

Drug reaction with eosinophilia and systemic symptoms associated with carbamazepine (DRESS syndrome) – case report and literature review

“…Chociaż patogeneza zespołu nie została w pełni poznana, to za główną przyczynę jego rozwoju uznaje się osobniczo zmienną reakcję na działanie leku (idiosynkrazja) związaną z upośledzeniem mechanizmów detoksykacji metabolitów niektórych leków, najczęściej aromatycznych preparatów przeciwdrgawkowych (karbamazepina, fenytoina, lamotrygina, fenobarbital), leków przeciwprątkowych, rzadziej minocykliny, allopurinolu, sulfonamidów czy dapsonu [5,6]. Z tego powodu, w przeciwieństwie do innych reakcji polekowych, zmiany pojawiają się późno, zwykle po kilku tygodniach, a nawet 3 miesiącach od rozpoczęcia terapii.…”

“…Częstość występowania DRESS szacuje się na 1,2-6 : 1 000 000 osób rocznie, natomiast u pacjentów przyjmujących leki przeciwdrgawkowe na 1 : 10 000 do 1 : 1000. Prawdopodobnie jest ona zaniżona z powodu zbyt rzadkiego rozpoznawania zespołu [6].…”

A Case of Drug-Induced Hypersensitivity Syndrome with Recurrent Varicella

“…On the fifth day of illness, histopathological examination of the skin revealed lymphocytic infiltration and vacuolar degeneration at the epidermal-dermal junction, as well as mild lymphocytic infiltration and edema in the superficial dermis. She had symptoms including liver dysfunction, atypical lymphocytes in peripheral blood, high-grade fever, lymphadenopathy along with typical eruption after cessation of carbamazepine as specific medications for DIHS, and was ultimately diagnosed as having atypical DIHS because there was no detection of reactivation of HHV-6 according to the diagnostic criteria [1,3]. Oral administration of prednisolone (PSL) at 50 mg (1 mg/kg)/day was started immediately, resulting in fever reduction within a few days and gradual resolution of the skin eruption.…”