title: Isolated ileal perforation due to cytomegalovirus reactivation during management of terbinafine hypersensitivity.
abstract: We report a case of 71-year-old man who developed a hypersensitivity syndrome associated with terbinafine. He was placed on terbinafine (250 mg/d) for the treatment of tinea pedis due to diabetes mellitus. Following the treatment with terbinafine, he developed drug-induced hypersensitivity syndrome (DIHS). Systemic corticosteroid led to transient improvement of his clinical manifestations. Three months after disease onset, he presented with panperitonitis due to ileal perforation, and underwent an emergency operation. The affected ileum was resected and ileostomy was performed in the terminal ileum. Cytomegalovirus (CMV)-specific IgG antibodies were significantly increased, high-titer CMV antigenemia was detected, and pathological examination of the resected ileum confirmed CMV infection. Based on these observations, we strongly recommend that physicians monitor reactivation of the family of herpesvirus other than herpesvirus 6, to manage DIHS properly.
authors.affiliation: Department of Internal Medicine, Osaka City General Hospital, Osaka 534-0021, Japan.
authors.forename: Soichi
authors.initials: S
authors.lastname: Sano
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ueno
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamagami
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yakushiji
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Isaka
authors.forename: Isao
authors.initials: I
authors.lastname: Kawasaki
authors.forename: Masashi
authors.initials: M
authors.lastname: Takemura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hosoi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000150:complications*; D004342:Drug Hypersensitivity / Q000150:complications* / Q000188:drug therapy; D020031:Epstein-Barr Virus Infections / Q000209:etiology; D015654:Herpesvirus 6, Human; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology*; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D009281:Naphthalenes / Q000009:adverse effects*; D012008:Recurrence; D019349:Roseolovirus Infections / Q000209:etiology; D000077291:Terbinafine; D014008:Tinea Pedis / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D009281:Naphthalenes; D000077291:Terbinafine