title: Drug-induced hypersensitivity syndrome due to mexiletine associated with human herpes virus 6 and cytomegalovirus reactivation.
abstract: A 66-year-old man developed a fever of 38 degrees C and generalized pruritic rash about one month after mexiletine hydrochloride administration for ventricular tachycardia. The rash appeared as edematous erythema and papules with purpura on the lower extremities. Liver dysfunction, leukocytosis, and atypical lymphocytes were also present. Elevated antibody titer against human herpes virus 6 (HHV-6) was detected during the course of the disease (1:20 -> 1:640). The patient was diagnosed as having drug-induced hypersensitivity syndrome (DIHS) due to mexiletine. Discontinuation of the mexiletine administration and systemic corticosteroid treatment led to a temporary improvement, but tapering the corticosteroid dose twice led to recrudescence. Simultaneous with the recrudescence, elevated antibody titers against HHV-6 and cytomegalovirus were detected, as well as viral DNA in the blood, suggesting that these two viruses may have been involved in the recrudescence. The patient died of myocarditis, most likely related to cytomegalovirus. Our case indicates that, in addition to HHV-6, other herpes viruses such as cytomegalovirus can be reactivated in DIHS and may modify the clinical disease activity.
authors.affiliation: Department of Dermatology, Asahikawa Medical College, Asahikawa 078-8510, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Sekiguchi
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kashiwagi
authors.forename: Akemi
authors.initials: A
authors.lastname: Ishida-Yamamoto
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hashimoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kimura
authors.forename: Mikiko
authors.initials: M
authors.lastname: Tohyama
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Iizuka
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D020803:Encephalitis, Herpes Simplex / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D005148:Facial Dermatoses / Q000097:blood / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D017809:Fatal Outcome; D015654:Herpesvirus 6, Human; D006801:Humans; D008297:Male; D008801:Mexiletine / Q000009:adverse effects*; D009203:Myocardial Infarction; D017180:Tachycardia, Ventricular / Q000188:drug therapy
chemical_list: D000889:Anti-Arrhythmia Agents; D008801:Mexiletine