title: A case of hypersensitivity syndrome induced by methimazole for Graves' disease.
abstract: Drug-induced hypersensitivity syndrome is one of the most severe forms of drug eruption and is characterized by high fever and multiorgan involvement. Reactivation of human herpesvirus-6 (HHV-6) or cytomegalovirus (CMV) has been suggested to be involved in this syndrome, although the exact role of these viruses remains elusive. We report the case of a 50-year-old Japanese male with Graves' disease who developed hypersensitivity syndrome caused by the antithyroid drug methimazole (MMI). After treatment with MMI 30 mg three times daily for 1(1/2) months, the patient developed generalized exfoliative erythematous eruption and high fever. Cessation of treatment with the drug improved his condition. Readministration of MMI worsened his clinical features. Treatment with high-dose methylprednisolone for 6 days and subsequent administration of prednisolone 20 mg twice daily improved his clinical manifestations. Elevated titers of anti-HHV-6 immunoglobulin G (IgG) and anti-CMV IgG antibodies were observed, and these gradually decreased during the clinical course, indicating reactivation of HHV-6 and CMV. Drug-induced lymphocyte stimulation test for MMI was negative. This is the first reported case of MMI-induced hypersensitivity syndrome associated with the reactivation of HHV-6 and CMV.
authors.affiliation: Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan. n-ozaki@med.nagoya-u.ac.jp
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Ozaki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Miura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sakakibara
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Oiso
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D013956:Antithyroid Agents / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000187:drug effects; D004342:Drug Hypersensitivity / Q000209:etiology*; D006111:Graves Disease / Q000188:drug therapy*; D015654:Herpesvirus 6, Human / Q000187:drug effects; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008713:Methimazole / Q000009:adverse effects*; D008875:Middle Aged; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000914:Antibodies, Viral; D013956:Antithyroid Agents; D007075:Immunoglobulin M; D008713:Methimazole