Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection.
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.
Descamps
V
V
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
Mahe
E
E
Houhou
N
N
Abramowitz
L
L
Rozenberg
F
F
Ranger-Rogez
S
S
Crickx
B
B
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
D000963:Antimetabolites; D000493:Allopurinol