Drug-induced hypersensitivity syndrome with human herpesvirus-6 reactivation

Indian J Dermatol Venereol Leprol. 2012 Mar-Apr;78(2):175-7. doi: 10.4103/0378-6323.93635.

Abstract

A 45-year-old man, on carbamazepine for the past 3 months, was referred as a case of atypical measles. On examination, he had high-grade fever, generalized itchy rash, cough, vomiting and jaundice. A provisional diagnosis of drug hypersensitivity syndrome to carbamazepine was made with a differential diagnosis of viral exanthema with systemic complications. Laboratory investigations revealed leukocytosis with eosnophilia and elevated liver enzymes. Real-time multiplex polymerase chain reaction (PCR) on throat swab and blood was suggestive of human herpesvirus-6 (HHV-6). Measles was ruled out by PCR and serology. The diagnosis of drug-induced hypersensitivity syndrome (DIHS) was confirmed, which could explain all the features manifested by the patient. HHV-6 infects almost all humans by age 2 years. It infects and replicates in CD4 T lymphocytes and establishes latency in human peripheral blood monocytes or macrophages and early bone marrow progenitors. In DIHS, allergic reaction to the causative drug stimulates T cells, which leads to reactivation of the herpesvirus genome. DIHS is treated by withdrawal of the culprit drug and administration of systemic steroids. Our patient responded well to steroids and HHV-6 was negative on repeat real-time multiplex PCR at the end of treatment.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticonvulsants / adverse effects
  • Carbamazepine / adverse effects*
  • Drug Eruptions / etiology*
  • Drug Eruptions / virology*
  • Herpesvirus 6, Human*
  • Humans
  • Male
  • Middle Aged
  • Roseolovirus Infections / virology*
  • Virus Activation / drug effects*

Substances

  • Anticonvulsants
  • Carbamazepine