Amoxicillin-induced flare in patients with DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms): report of seven cases and demonstration of a direct effect of amoxicillin on Human Herpesvirus 6 replication in vitro.
Amoxicillin is known to induce exanthema in patients with EBV-induced infectious mononucleosis. It is widely recognized that the reactivation of herpesviruses, including HHV-6 (Human Herpesvirus 6) and EBV (Epstein Barr virus) is associated with DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms). We report 7 cases of amoxicillin-induced flare in patients with DRESS induced by other drugs and investigate whether amoxicillin may have a direct effect on HHV-6 replication in vitro. 7 cases of DRESS with amoxicillin-induced flare were retrospectively analysed. The influence of amoxicillin on HHV-6 HST strain replication was studied in vitro in a human T lymphoblastoid MT4 cell line. The viral replication was quantified by immunofluorescence assay and by real-time polymerase chain reaction (PCR). Comparisons were performed using the Student's t test. Amoxicillin-induced flare was observed in 7 patients with DRESS induced by other drugs. In two cases HHV-6 reactivation was studied and was demonstrated by PCR. Amoxicillin neither modified cell viability nor cell proliferation for the range of tested concentrations. Amoxicillin increased the replication of HHV-6 at 25 microg*mL-1 and 50 microg*mL-1. Amoxicillin may induce a flare of DRESS, possibly by acting directly on herpesvirus replication.
Mardivirin
Laurent
L
Department of Virology, Centre Hospitalier Universitaire Dupuytren, Limoges, France.
Valeyrie-Allanore
Laurence
L
Branlant-Redon
Estelle
E
Beneton
Nathalie
N
Jidar
Kaoutar
K
Barbaud
Annick
A
Crickx
Béatrice
B
Ranger-Rogez
Sylvie
S
Descamps
Vincent
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000009:adverse effects* / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology; D002460:Cell Line; D002478:Cells, Cultured; D004342:Drug Hypersensitivity / Q000209:etiology*; D004802:Eosinophilia / Q000139:chemically induced*; D005260:Female; D015654:Herpesvirus 6, Human / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013577:Syndrome; D014775:Virus Activation / Q000187:drug effects; D014779:Virus Replication / Q000187:drug effects*
D000900:Anti-Bacterial Agents; D000658:Amoxicillin