Erythroderma due to Zonisamide (Excegran^®) : Reappearance of Skin Lesion Resembling DIHS after the Cessation of Steroid Treatment

Abstract

　A 63-year-old woman presented with a 19-day history of erythroderma that had appeared 20 days after taking zonisamide (Excegran^®) at a dose of 200 mg/day to prevent seizures after craniotomy. Physical examination revealed a fever of 38.6℃, erythroderma with fused red spots on the trunk below the neck and on the extremities without enanthem, lymphadenopathy, and liver dysfunction. The rash quickly disappeared after steroid pulse therapy followed by oral prednisolone (PSL) at a dose of 30 mg/day. Two days after completion of oral PSL therapy, the rash reappeared on the face and trunk. PSL was initiated at a dose of 25 mg/day, then gradually decreased, followed by no recurrence. This case is unique in that DIHS-like erythema reappeared without fever or organ involvement, although anti-human herpesvirus 6 (HHV-6) IgG was elevated throughout the course of the disease.