Toxic epidermal necrolysis due to zonisamide associated with reactivation of human herpesvirus 6.
BACKGROUND
Recently, human herpesvirus 6 (HHV-6) reactivation has been frequently observed in patients with drug-induced hypersensitivity syndrome or drug rash with eosinophilia and systemic symptoms but not in patients with other types of drug eruptions, eg, Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). This finding suggests that there is a close relationship between HHV-6 reactivation and drug-induced hypersensitivity syndrome.


METHODS
A 71-year-old man who was not immunocompromised developed TEN because of zonisamide therapy. After the onset of the rash, significant increases in HHV-6 IgG titers and HHV-6 DNA levels were observed in the patient's whole blood samples, indicating that an HHV-6 reactivation had occurred. Furthermore, the patient's clinical manifestations of TEN appeared to recur concurrently with HHV-6 reactivation. Conclusion Our case suggests that HHV-6 reactivation may also occur in several types of drug eruptions, including Stevens-Johnson syndrome and TEN.
Teraki
Yuichi
Y
Department of Dermatology, Saitama Medical University, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan. teraki@saitama-med.ac.jp
Murota
Haruhiko
H
Izaki
Seiichi
S
D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects*; D004279:DNA, Viral / Q000097:blood; D015654:Herpesvirus 6, Human / Q000235:genetics / Q000276:immunology / Q000502:physiology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007555:Isoxazoles / Q000009:adverse effects*; D008297:Male; D013262:Stevens-Johnson Syndrome / Q000097:blood / Q000209:etiology* / Q000473:pathology; D014775:Virus Activation; D000078305:Zonisamide
D000927:Anticonvulsants; D004279:DNA, Viral; D007074:Immunoglobulin G; D007555:Isoxazoles; D000078305:Zonisamide