Different patterns of cytokines, ECP and immunoglobulin profiles at two adverse drug reactions in a patient.
OBJECTIVE
Drug-induced hypersensitivity syndrome (HS) is a rare but life-threatening disease. We experienced carbamazepine-induced HS in a 14-year-old boy, who had cefaclor-induced cutaneous eruptions 15 months later. To clarify the mechanisms of HS and the differences between two diseases we studied this case in detail.


METHODS
We investigated the associated viral agents by polymerase chain reaction and the specific antibodies. We also studied the mechanism of diseases by measuring chemical mediators including cytokines, ECP and immunoglobulins.


RESULTS
The patient was diagnosed as having carbamazepine-induced HS associated with reactivation of human herpesvirus 6 based on the clinical course and laboratory data including drug-induced lymphocyte stimulation tests. Similarly, the diagnosis of cefaclor-induced eruption without any viral reactivation was made. Serum levels of IFN-gamma, IL-6, TNF-alpha, IL-5 and ECP were increased significantly at HS but mildly at cefaclor-induced eruptions. Furthermore, we detected transient hypogammaglobulinemia only at HS.


CONCLUSIONS
This is the first report of anticonvulsant-induced HS followed by antibiotic-induced eruptions in a patient. In addition, we demonstrated difference in serum levels of inflammatory cytokines, immunoglobulins, activated eosinophils and viral reactivation between these diseases. This case would contribute to the understanding of the pathophysiology of adverse drug reactions including HS.
Aihara
Yukoh
Y
Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan. yaihara1@urahp.yokohama-cu.ac.jp
Ito
Shuichi
S
Aihara
Michiko
M
Kobayashi
Yoshinori
Y
Yokota
Shumpei
S
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000914:Antibodies, Viral / Q000097:blood*; D000927:Anticonvulsants / Q000009:adverse effects; D002220:Carbamazepine / Q000009:adverse effects; D002433:Cefaclor / Q000009:adverse effects; D016207:Cytokines / Q000097:blood*; D004342:Drug Hypersensitivity / Q000097:blood*; D047150:Eosinophil Cationic Protein / Q000097:blood*; D015654:Herpesvirus 6, Human / Q000502:physiology; D006801:Humans; D008297:Male; D013577:Syndrome; D014775:Virus Activation
D000900:Anti-Bacterial Agents; D000914:Antibodies, Viral; D000927:Anticonvulsants; D016207:Cytokines; D002220:Carbamazepine; D002433:Cefaclor; D047150:Eosinophil Cationic Protein; C479220:RNASE3 protein, human