title: Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection.
abstract: Association of drug-induced hypersensitivity syndrome with viral infection is debated. Human herpesvirus 6 (HHV-6) reactivation has been the most frequently reported infection associated with this syndrome. However, a case of cytomegalovirus (CMV) infection was recently described associated with anticonvulsant-induced hypersensitivity syndrome. We report a case of severe allopurinol-induced hypersensitivity syndrome with pancreatitis associated with Epstein-Barr virus (EBV) infection. Active EBV infection was demonstrated in two consecutive serum samples by the presence of anti-EBV early antigen (EA) IgM antibodies and an increase in anti-EBV EA IgG antibodies, whereas no anti-EBV nuclear antigen IgG antibodies were detected. EBV DNA was detected by polymerase chain reaction (PCR) in peripheral blood mononuclear cells. Reactivation of HHV-6 was suggested only by the presence of anti-HHV-6 IgM antibodies, but HHV-6 DNA was not detected by PCR in the serum. Other viral investigations showed previous infection (CMV, rubella, measles, parvovirus B19), immunization after vaccination (hepatitis B virus), or absence of previous infection (hepatitis C virus, human immunodeficiency virus). We suggest that EBV infection may participate in some cases, as do the other herpesviruses HHV-6 or CMV, in the development of drug-induced hypersensitivity syndrome.
authors.affiliation: Department of Dermatology, Bichat Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France. vincent.descamps@bch.ap-hop-paris.fr
authors.forename: V
authors.initials: V
authors.lastname: Descamps
authors.forename: E
authors.initials: E
authors.lastname: Mahe
authors.forename: N
authors.initials: N
authors.lastname: Houhou
authors.forename: L
authors.initials: L
authors.lastname: Abramowitz
authors.forename: F
authors.initials: F
authors.lastname: Rozenberg
authors.forename: S
authors.initials: S
authors.lastname: Ranger-Rogez
authors.forename: B
authors.initials: B
authors.lastname: Crickx
mesh_terms: D000328:Adult; D000493:Allopurinol / Q000009:adverse effects*; D000963:Antimetabolites / Q000009:adverse effects*; D004342:Drug Hypersensitivity / Q000821:virology*; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D004854:Herpesvirus 4, Human; D015654:Herpesvirus 6, Human / Q000502:physiology; D006801:Humans; D008297:Male; D010195:Pancreatitis / Q000821:virology; D019349:Roseolovirus Infections / Q000150:complications; D013577:Syndrome; D014775:Virus Activation
chemical_list: D000963:Antimetabolites; D000493:Allopurinol