Virus reactivation and intravenous immunoglobulin (IVIG) therapy of drug-induced hypersensitivity syndrome

Kano, Yoko; Inaoka, Miyuki; Sakuma, K.; Shiohara, Tetsuo

doi:10.1016/j.tox.2004.12.013

Cited by 66 publications

(38 citation statements)

References 9 publications

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“…In addition to high-dose prednisolone (PSL) therapy, high-dose intravenous immunoglobulin therapy has also been reported in severe DIHS (24). HHV-6 reactivation is usually temporary, requiring no therapeutic intervention.…”

Section: Discussionmentioning

confidence: 99%

Drug-induced Liver Injury with HHV-6 Reactivation

et al. 2015

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Liver dysfunction was identified in a 16-year-old boy hospitalized with high fever and abdominal pain and fullness. He had received pharmacotherapy for a headache 2 months previously and other drugs for a high fever 4 days prior to being admitted to our hospital. The patient's liver dysfunction was consistent with and fulfilled the criteria for drug induced liver injury, but the laboratory findings showed elevated procalcitonin levels, hyponatremia and leukocytosis. Moreover, we confirmed the presence of human herpesvirus 6 (HHV-6) DNA. The patient exhibited symptoms of high fever and abdominal pain and fullness but no exanthema. The clinical and laboratory findings did not satisfy the criteria for drug-induced hypersensitivity syndrome, and we speculate that the diversity of clinical and laboratory findings may have resulted from HHV-6 reactivation. To the best of our knowledge, this is the first case report on drug-induced liver injury with various findings due to HHV-6 reactivation. HHV-6 reactivation should be considered in patients with drug induced liver injury even in the absence of exanthema.

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Section: Discussionmentioning

confidence: 99%

Drug-induced Liver Injury with HHV-6 Reactivation

et al. 2015

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“…A number of recent reports have suggested that drug-induced hypersensitivity syndrome, characterized by serious adverse systemic reactions in addition to skin rash, is associated with the reactivation of human herpesviruses, mainly HHV-6 (34,35). Indeed, in this case, viral infection exacerbates allergic diseases.…”

Section: Discussionmentioning

confidence: 99%

Down-Regulation of Basophil Function by Human CD200 and Human Herpesvirus-8 CD200

Shiratori

Yamaguchi

Suzukawa

et al. 2005

The Journal of Immunology

103

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Human and rodent CD200 are recognized by the inhibitory CD200R, and these molecules play an important role in the regulation of the immune system. Several viruses, such as human herpesvirus-6 (HHV-6), HHV-7, and HHV-8, possess a CD200 homologue, suggesting that these viruses regulate the immune response via CD200R. In this study, we analyzed the effect of human CD200 and the viral CD200 homologues on human CD200R-expressing cells. We found that human CD200R is predominantly expressed on basophils in amounts higher than on other human peripheral blood leukocytes. Furthermore, the viral CD200 homologues as well as human CD200 were recognized by human CD200R, and the activation of basophils was down-regulated by these CD200 proteins. These results suggested that CD200R is an important regulatory molecule of basophil activation. In addition, the presence of CD200 homologues on several viruses suggests a potentially unique relationship between basophil function and viral infection.

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“…Our patient had hypogammaglobulinaemia; therefore, she was treated with IVIG in addition to intravenous corticosteroid. Although the exact mechanism is unknown, we expected that IVIG compensates for the decreased immunoglobulin concentration and the therapeutic effect of IVIG in DIHS/DRESS may be partially due to the presence of anti-viral IgG in IVIG (5). In many reports, however, DIHS/DRESS have not been successfully treated with IVIG alone, and the IVIG may have paradoxically exacerbated hypogammaglobulinaemia (indeed, serum IgG levels gradually decreased despite administration of IVIG in this case).…”

Section: Discussionmentioning

confidence: 79%