title: A case of drug-induced hypersensitivity syndrome with multiple organ involvement treated with plasma exchange.
abstract: A 53-year-old male patient began treatment for systemic exanthema with diaphenylsulfone (DHS) on 21 November 2002. On 18 December 2002, the patient developed a fever and additional systemic erythematous exanthema. Systemic lymphadenopathy, hepatosplenomegaly, leukocytosis (in particular, an increase in the number of atypical lymphocytes) and liver dysfunction followed. After cessation of the DHS treatment on 25 December 2002, acute renal failure occurred and the patient was transferred to Shinshu University Hospital on 4 January 2003. The patient was diagnosed with drug-induced hypersensitivity syndrome (DIHS). Steroid pulse therapy (methylprednisolone 1000 mg/day for 3 days) was given, followed by 60 mg/day of prednisolone. The patient's renal functions recovered and he was taken off hemodialysis therapy. However, the patient relapsed twice despite two sessions of steroid pulse therapy and an increase in the dose of prednisolone to 100 mg/day. Plasma exchange (PE) was carried out to reduce the activity of the disease. With a total of four plasma exchanges, we were able to reduce the dose of prednisolone from 100 mg/day to 60 mg/day without relapse. There were no adverse effects from the plasma exchanges. Plasma exchange should be considered in the treatment with corticosteroid-resistant DIHS with multiple organ lesions.
authors.affiliation: Department of Internal Medicine (2, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Higuchi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Agatsuma
authors.forename: Miwako
authors.initials: M
authors.lastname: Iizima
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Yamazaki
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saita
authors.forename: Tohru
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kamijo
authors.forename: Hideo
authors.initials: H
authors.lastname: Arakura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hora
authors.forename: Kendo
authors.initials: K
authors.lastname: Kiyosawa
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D003622:Dapsone / Q000009:adverse effects; D003875:Drug Eruptions / Q000150:complications / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D013577:Syndrome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D003622:Dapsone