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      Anticonvulsant Hypersensitivity Syndrome Associated with Epstein-Barr Virus Reactivation

      case-report

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          Abstract

          We describe a 59-year-old female with severe anticonvulsant hypersensitivity syndrome (AHS) associated with Epstein-Barr virus (EBV) infection. The causative drug was speculated to be carbamazepine. Recurrent EBV infection was demonstrated by the presence of anti-EBV early antigen IgM antibodies and anti-EBV nuclear antigen IgG antibodies. To our knowledge, only one case of drug hypersensitivity syndrome (DHS) associated with EBV has been reported in the English-language literature. Our case is the second report of EBV-associated DHS, which suggests that EBV infection may contribute to the pathogenesis of AHS in a few patients.

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          Most cited references13

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          The drug hypersensitivity syndrome: what is the pathogenesis?

          N. Shear, Rachael Sullivan (2001)
          Article 0 comments Cited 33 times – based on 0 reviews     Review now
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            Association between anticonvulsant hypersensitivity syndrome and human herpesvirus 6 reactivation and hypogammaglobulinemia.

            Tetsuo Shiohara, Miyuki Inaoka, Yoko Kano (2004)
            Anticonvulsant hypersensitivity syndrome (AHS) is a life-threatening, drug-induced, multiorgan system reaction. The identification of predisposing factors is clearly needed to predict the incidence and outcome of AHS; attention has recently been focused on reactivation of human herpesvirus 6 (HHV-6). To determine whether immunosuppressive conditions that can allow HHV-6 reactivation could be specifically detected in association with the onset of AHS. We analyzed patients with AHS who were treated during 1997-2002. Two groups of patients receiving anticonvulsants served as controls. Department of Dermatology, Kyorin University School of Medicine, Tokyo, Japan. Patients Ten patients with AHS. The results of serologic tests for antibody titers for various viruses, including HHV-6, HHV-6 DNA detection by real-time polymerase chain reaction, immunoglobulin levels by turbidimetric immunoassay, IgG subclass levels by nephelometry, and CD19(+) B-cell counts by flow cytometric analysis, were sequentially assessed. Serum IgG levels (mean, 745 mg/dL) and circulating B-cell counts (mean, 88/ micro L) in patients with AHS were significantly decreased at onset compared with control groups (P<.001 and P =.007, respectively). These alterations returned to normal on full recovery. Reactivation of HHV-6 as judged by a greater than 4-fold increase in HHV-6 IgG titers was exclusively detected in most patients with AHS associated with decreased IgG levels and B-cell counts. A decrease in immunoglobulin levels and B-cell counts can be associated with HHV-6 reactivation and the subsequent onset of AHS. These immunological alterations might be a useful predictor of the development of AHS.
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              Management of drug rash with eosinophilia and systemic symptoms (DRESS syndrome): an update.

              T Simonart, S Tas (2002)
              Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rather distinct severe adverse drug reaction characterised by skin rash, fever, lymph node enlargement and internal organ involvement. Our aim was to review the available data regarding the management of this probably underrecognised subset of drug reaction. So far, the only undisputed way to treat severe hypersensitivity reactions is prompt withdrawal of the offending drug. The use of systemic corticosteroids remains controversial. The benefit of therapies aimed at accelerating the elimination of the causative drug deserves further studies. In the absence of a well-established therapy, primary and secondary prevention have a key role in the management of DRESS syndrome. Copyright 2003 S. Karger AG, Basel
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                Author and article information

                Journal
                Journal ID (nlm-ta): Yonsei Med J
                Journal ID (publisher-id): YMJ
                Title: Yonsei Medical Journal
                Publisher: Yonsei University College of Medicine
                ISSN (Print): 0513-5796
                ISSN (Electronic): 1976-2437
                Publication date (Print): 30 April 2007
                Publication date (Electronic): 30 April 2007
                Volume: 48
                Issue: 2
                Pages: 317-320
                Affiliations
                Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
                Author notes
                Reprint address: requests to Dr. Soo-Chan Kim, Department of Dermatology, Yonsei University College of Medicine, Yongdong Severance Hospital, 146-92 Dogok-dong, Kangnam-gu, Seoul 135-720, Korea. Tel: 82-2-2019-3362, Fax: 82-2-3463-6136, kimsc@ 123456yumc.yonsei.ac.kr
                Article
                DOI: 10.3349/ymj.2007.48.2.317
                PMC ID: 2628108
                PubMed ID: 17461533
                SO-VID: e41df9d6-1577-4408-8f13-ec6c783351a7
                Copyright © Copyright © 2007 The Yonsei University College of Medicine
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 17 November 2005
                Date accepted : 05 April 2006
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Keywords: carbamazepine,hypersensitivity syndrome,epstein-barr virus
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: carbamazepine, hypersensitivity syndrome, epstein-barr virus

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