2017 Volume 11 Issue 2 Pages 121-129
A 51-years-old woman with rheumatoid arthritis started taking salazosulfapyridine (SASP) 1,000 mg/day and celecoxib at 200 mg/day. She developed high fever and erythematous eruption over her entire body after 27 days of treatment. The skin rash remained for over 2 weeks, and the laboratory data showed eosinophilia, liver dysfunction with two peaks, and reactivation of human herpes virus-6. Thus, we diagnosed typical drug-induced hypersensitivity syndrome (DIHS) . Drug-induced lymphocyte stimulation test (DLST) and skin patch test with celecoxib were also positive. We suspected that celecoxib was the culprit drug. However, in previous reports, most DIHS caused by SASP had negative DLST and negative skin prick test, indicating SASP was also a possible culprit drug in this case. As serum TARC level can be an early diagnostic marker of DIHS, we measured her serum TARC level, and found 3,954.2 pg/ml on the day of first visit and the highest level of 13,9441.1 pg/ml on day 18. The present case indicates that serum TARC level is a good marker for DIHS.
