title: 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.
abstract: 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.
authors.affiliation: Department of Virology, Centre Hospitalier Universitaire Dupuytren, Limoges, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mardivirin
authors.forename: Laurence
authors.initials: L
authors.lastname: Valeyrie-Allanore
authors.forename: Estelle
authors.initials: E
authors.lastname: Branlant-Redon
authors.forename: Nathalie
authors.initials: N
authors.lastname: Beneton
authors.forename: Kaoutar
authors.initials: K
authors.lastname: Jidar
authors.forename: Annick
authors.initials: A
authors.lastname: Barbaud
authors.forename: Béatrice
authors.initials: B
authors.lastname: Crickx
authors.forename: Sylvie
authors.initials: S
authors.lastname: Ranger-Rogez
authors.forename: Vincent
authors.initials: V
authors.lastname: Descamps
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D000658:Amoxicillin