Abstract
Drug-induced hypersensitivity syndrome (DIHS), which is a severe drug eruption with serious systemic reactions, is frequently associated with reactivation of human herpesvirus (HHV)-6. We examined HHV infection in patients with DIHS, toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), erythema exsudativum multiforme (EEM), and maculopapular examthema (MP) in order to clarify the involvement of HHV infection in the pathogenesis of these diseases. Samples of serum and peripheral white blood cells from 41 patients (DIHS, 10; TEN, 5; SJS, 4; EEM, 6; MP, 16) were tested to examine increases of virus specific antibody titers, HHV DNA detection by polymerase chain reaction, and CMV pp65 antigen detection. HHV-6 reactivation was observed in seven patients with DIHS. Among them, four patients presented other HHV activation. Of the three patients who did not show HHV-6 reactivation, CMV reactivation was observed in one patient and both CMV and HSV reactivation in another. Of the patients with other eruptions, two showed HHV-6 reactivation, and seven patients had active infections of HHV-7, CMV, or HSV. Increases in IgG titers for HHV-6 in patients with DIHS were more evident than in others. No relationship between viral activation and corticosteroid therapy or low-level serum immunoglobulin was found. We suggest that HHV-6 reactivation is a specific event in DIHS.
