Drug Reaction with Eosinophilia and Systemic Symptoms Associated with Reactivation of Epstein-Barr Virus and/or Cytomegalovirus Leading to Hemophagocytic Syndrome in One of Two Patients = Drug Reaction with Eosinophilia and Systemic Symptoms Associated with Reactivation of Epstein-Barr Virus and/or Cytomegalovirus Leading to Hemophagocytic Syndrome in One of Two Patients

다국어 초록 (Multilingual Abstract)

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a hypersensitivity reaction characterized by maculopapular rash, exfoliative dermatitis, lymphadenopathy, fever, eosinophilia, and involvement of internal organs. Evidence for reactivation of herpes family viruses has been observed in some DRESS patients, and activated CD8+ T lymphocytes are largely directed against Epstein-Barr virus. Here, we report two cases complicated with this infection. Both patients received antibiotics and non-steroidal anti-inflammatory drugs. These patients manifested clinically with high fever, facial edema, diffuse pruritic erythroderma and maculopapules over the entire body, purpuric rashes in both lower limbs and lymphadenopathy of cervical and inguinal nodes. Laboratory tests revealed abnormal liver function, blood eosinophils, and ferritin levels. The patients recovered completely; however, the female patient developed hemophagocytic syndrome on the 15th day of illness. She developed new itchy rash, and laboratory tests rapidly worsened with fibrinogen levels dramatically reduced to 0.61 g/L. Bone marrow aspiration revealed an increased number of macrophages with hemophagocytosis and a reversed CD4/CD8 ratio of 0.45. These cases suggest that human herpes virus and coagulation function evaluations are necessary in DRESS patients. (Ann Dermatol 30(1) 71∼74, 2018)

참고문헌 (Reference)

1 Kardaun SH, "Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist" 156 : 609-611, 2007

2 Filipovich AH, "The expanding spectrum of hemophagocytic lymphohistiocytosis" 11 : 512-516, 2011

3 Ishida T, "The dynamics of herpesvirus reactivations during and after severe drug eruptions: their relation to the clinical phenotype and therapeutic outcome" 69 : 798-805, 2014

4 Nishio D, "T cell populations propagating in the peripheral blood of patients with drug eruptions" 48 : 25-33, 2007

5 Komatsuda A, "Sulfasalazine-induced hypersensitivity syndrome and hemophagocytic syndrome associated with reactivation of Epstein-Barr virus" 27 : 395-397, 2008

6 Nanishi E, "Drug reaction with eosinophilia and systemic symptoms during primary Epstein-Barr virus infection" 48 : 109-112, 2015

7 Picard D, "Drug reaction with eosinophilia and systemic symptoms (DRESS): a multiorgan antiviral T cell response" 2 : 46ra62-, 2010

8 Picard M, "Ceftazidime-induced drug reaction with eosinophilia and systemic symptoms (DRESS) complicated by hemophagocytic lymphohistiocytosis" 1 : 409-412, 2013

9 Girelli F, "A new case of DRESS syndrome induced by sulfasalazine and triggered by amoxicillin" 2013 : 409152-, 2013

10 Drago F, "A fatal case of DRESS induced by strontium ranelate associated with HHV-7 reactivation" 27 : 1261-1264, 2016