title: Probable case of drug reaction with eosinophilia and systemic symptom syndrome due to combination therapy with daclatasvir and asunaprevir.
abstract: A 66-year-old, interferon-ineligible, treatment-naive man who was diagnosed with chronic hepatitis C due to hepatitis C virus genotype 1b began combination therapy with daclatasvir and asunaprevir. On day 14 of treatment, hepatic reserve and renal function deterioration was observed, while his transaminase levels were normal. Both daclatasvir and asunaprevir were discontinued on day 18 of treatment, because the patient complained of dark urine and a rash on his trunk and four limbs. After discontinuing antiviral therapy, the abnormal laboratory finding and clinical manifestations gradually improved, without recurrence. Our case fulfilled the diagnostic criteria of probable drug reaction with eosinophilia and systemic symptom (DRESS) syndrome. Despite the 18-d treatment, sustained virological response 12 was achieved. Based on the clinical course, we concluded that there was a clear cause-and-effect relationship between the treatment and adverse events. To our knowledge, this patient represents the first case of probable DRESS syndrome that includes concomitant deterioration of hepatic reserve and renal function due to combination therapy with daclatasvir and asunaprevir, regardless of normalization of transaminase levels. Our case suggests that we should pay attention not only to the transaminase levels but also to allergic symptoms associated with organ involvement during combination therapy with daclatasvir and asunaprevir.
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Suga
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamazaki
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ohyama
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Horiguchi
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Motoyasu
authors.initials: M
authors.lastname: Kusano
authors.affiliation: Takayoshi Suga, Ken Sato, Yuichi Yamazaki, Tatsuya Ohyama, Norio Horiguchi, Satoru Kakizaki, Masanobu Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yamada
keywords: Asunaprevir; Daclatasvir; Hepatic reserve deterioration; Hepatitis C; Renal dysfunction