Drug reaction with eosinophilia and systemic symptoms, or virus reactivation with eosinophilia and systemic symptoms as a manifestation of immune reconstitution inflammatory syndrome in a patient with HIV?
We report a case of drug reaction with eosinophilia and systemic symptoms (DRESS) in a patient with HIV receiving antitoxoplasmic drugs (adiazine and pyrimethamine) and levetiracetam along with highly active antiretroviral therapy (tenofovir-emtricitabine, darunavir and ritonavir). Cytomegalovirus (CMV) infection was reactivated in the 7 weeks before the development of DRESS but was successfully treated with ganciclovir and corticosteroids. DRESS flare was concomitant with another CMV reactivation after the withdrawal of ganciclovir. This case report is an example of DRESS that may be considered real DRESS or virus reactivation with eosinophilia and systemic symptoms (VRESS) as a manifestation of immune reconstitution inflammatory syndrome. The case confirms that herpesvirus reactivation precedes DRESS or VRESS, and suggests the need to monitor herpesvirus infection in patients at risk for the infection or after the initiation of culprit drugs.
Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique des Hôpitaux de Paris, Paris 7 Denis Diderot University, 46 rue Henri Huchard 75877, Paris, France.
A
A
Almudimeegh
C
C
Rioux
H
H
Ferrand
B
B
Crickx
Y
Y
Yazdanpanah
V
V
Descamps
D000981:Antiprotozoal Agents / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000139:chemically induced; D003937:Diagnosis, Differential; D063926:Drug Hypersensitivity Syndrome / Q000175:diagnosis* / Q000209:etiology; D004802:Eosinophilia / Q000139:chemically induced; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000150:complications*; D008875:Middle Aged; D016781:Toxoplasmosis, Cerebral / Q000188:drug therapy; D014775:Virus Activation
D000981:Antiprotozoal Agents