Drug-induced hypersensitivity syndrome associated with cytomegalovirus reactivation: immunological characterization of pathogenic T cells.
We report a case of tribenoside-induced hypersensitivity syndrome associated with cytomegalovirus reactivation and investigation of the immunological characteristics of the circulating and skin-infiltrating lymphocytes. Activated CD8+ T cells outnumbered CD4+ cells in both the circulation and the skin lesions. Upon in vitro stimulation with the drug, CD4+ cells proliferated and produced interferon-gamma. The circulating CD8+ cells used limited T-cell receptor Vbetas, some of which are restricted to cytomegalovirus-derived peptide in the context of the HLA-A2 haplotype. CD8+ cells and cytomegalovirus-containing cells closely co-localized in the skin lesions. These results suggested that CD4+ cells were drug-reactive, whereas cytomegalovirus activated CD8+ cells in the present case. These two cell types seemed to play a distinct role in drug-induced hypersensitivity syndrome.
Hashizume
Hideo
H
Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan. hihashiz@hama-med.ac.jp
Takigawa
Masahiro
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000914:Antibodies, Viral / Q000097:blood; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000276:immunology; D004342:Drug Hypersensitivity / Q000209:etiology*; D016679:Genome, Viral; D006027:Glycosides / Q000009:adverse effects*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D007371:Interferon-gamma / Q000096:biosynthesis; D015847:Interleukin-4 / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D016693:Receptors, Antigen, T-Cell, alpha-beta / Q000378:metabolism; D012867:Skin / Q000378:metabolism; D014775:Virus Activation
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000914:Antibodies, Viral; D006027:Glycosides; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D016693:Receptors, Antigen, T-Cell, alpha-beta; D015847:Interleukin-4; D007371:Interferon-gamma; C100302:tribenoside