title: Drug-induced hypersensitivity syndrome associated with a marked increase in anti-paramyxovirus antibody titers in a scleroderma patient.
abstract: BACKGROUND
  Drug-induced hypersensitivity syndrome (DIHS) is characterized by a severe multiorgan hypersensitivity reaction that usually appears after prolonged exposure to certain drugs and may be related to reactivation of herpes viruses. There have been few reports regarding the clinical association of DIHS with pathogens other than herpes viruses.
  
  
  METHODS
  We report a case of scleroderma with DIHS associated with paramyxovirus infection. A 61-year-old man with early diffuse cutaneous scleroderma with myositis and progressive interstitial pneumonia developed generalized erythema with high fever 3 weeks after taking sulfamethoxazole/trimethoprim. The diagnosis of DIHS was made based on the patient's history of using an offending drug, clinical manifestations and laboratory data showing peripheral eosinophilia with the presence of atypical lymphocytes. Virological tests showed significant increases of antibody titers against mumps virus and parainfluenza virus type 2, which strongly suggested that paramyxovirus infection occurred during the clinical course of DIHS.
  
  
  CONCLUSIONS
  These findings suggest that paramyxovirus infection had contributed to the development of DIHS in this patient and that there is a need to seek evidence of other viral infections in some cases of DIHS, especially those without herpes virus reactivation/infection.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine and Molecular Science, Aichi, Japan. tnaniwa@med.nagoya-cu.ac.jp
authors.forename: Taio
authors.initials: T
authors.lastname: Naniwa
authors.forename: Shinji
authors.initials: S
authors.lastname: Maeda
authors.forename: Hiroo
authors.initials: H
authors.lastname: Sawada
authors.forename: Yuko
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Tomoyo
authors.initials: T
authors.lastname: Osawa
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Hayami
authors.forename: Shogo
authors.initials: S
authors.lastname: Banno
authors.forename: Akimichi
authors.initials: A
authors.lastname: Morita
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Ueda
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D004342:Drug Hypersensitivity / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D010223:Parainfluenza Virus 2, Human / Q000276:immunology*; D018184:Paramyxoviridae Infections / Q000276:immunology; D045743:Scleroderma, Diffuse / Q000150:complications* / Q000188:drug therapy; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects* / Q000276:immunology
chemical_list: D000893:Anti-Inflammatory Agents; D000914:Antibodies, Viral; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008775:Methylprednisolone