Cases reported "Drug Hypersensitivity"

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1/33. Hypersensitivity syndrome due to 2 anticonvulsant drugs.

    Drug-induced hypersensitivity syndrome is a multiorgan-system reaction characterized by fever, pleomorphic eruption, lymphadenopathy, eosinophilia, lymphocytosis and hepatitis. We report a drug hypersensitivity syndrome in a 6-year-old Tunisian child treated for epileptic absences with sodium valproate and ethosuximide. Imputability of these 2 drugs is probable because of the chronological and clinical features. Positive rechallenge with ethosuximide confirmed the toxicity of this drug. sodium valproate was also responsible because patch testing was positive and followed by a generalized eruption. Human herpesvirus 6 (HHV6) antibody titers increased significantly within 15 days. There was a favourable outcome after discontinuation of the drugs and corticosteroid therapy. Our case is interesting because this drug hypersensitivity syndrome occurred with non-aromatic anticonvulsant drugs. It is the 1st case with ethosuximide and the 2nd with sodium valproate. We also observed a reactivation of HHV6 infection that may contribute to the development of this hypersensitivity syndrome.
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ranking = 1
keywords = herpesvirus, herpes
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2/33. Graded challenge in an aciclovir allergic patient.

    An immunocompetent woman presented with a hypersensitivity skin reaction following suppressive therapy with aciclovir for recurrent culture proved genital herpes simplex virus infection. She developed a similar reaction when treatment was changed to famciclovir. Without antiviral suppression her recurrences were frequent and distressing. Graded challenge was performed and she became tolerant to aciclovir. She successfully continued suppressive therapy for 1 year with no further hypersensitivity reactions or recurrences.
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ranking = 0.011821098332044
keywords = herpes
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3/33. Anticonvulsant hypersensitivity syndrome associated with reactivation of cytomegalovirus.

    Recently, it has been proposed that viral infection is involved in the pathogenesis of hypersensitivity syndrome. cytomegalovirus (CMV), one of the aetiological agents of infectious mononucleosis, has never been reported as an organism associated with hypersensitivity syndrome. We describe a 64-year-old man with severe phenytoin-induced hypersensitivity syndrome associated with CMV infection. Twenty-five days after the patient was started on phenytoin, he developed high fever and a generalized erythematous rash followed by jaundice, renal failure and disseminated intravascular coagulopathy (DIC). CMV-specific IgG antibodies were significantly increased 7 weeks after the onset of clinical symptoms and the increase was associated with the appearance of CMV-specific IgM. CMV dna was detected in the serum of the patient. coinfection with other viruses, such as Epstein-Barr virus and human herpesviruses 6 and 7, could be excluded because antibody titres to those viruses did not increase during the clinical course of his illness. We suggest that reactivation of CMV may contribute, at least in some cases, to the development of hypersensitivity syndrome.
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ranking = 11.54634697729
keywords = human herpesvirus, herpesvirus, herpes
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4/33. Hypersensitivity syndrome (DRESS) and meningoencephalitis associated with nevirapine therapy.

    The DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is a serious condition that has been reported in association with various drugs, such as allopurinol, sulfonamides and aromatic anticonvulsants. Recently the condition has been described in hiv-infected patients taking antiretroviral agents. We report the first case, to our knowledge, of DRESS syndrome complicated by meningoencephalitis associated with nevirapine therapy.
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ranking = 0.21175456598504
keywords = encephalitis
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5/33. Possible relevance of virus infection for development of analgesic idiosyncrasy.

    Although it has been hypothesized that analgesic idiosyncrasy could be acquired by viral infection, there is no evidence that any virus can cause sporadic cases of aspirin-intolerant asthma. We report a case, which points to the possible relevance of herpes simplex virus (HSV) infection for development of analgesic idiosyncrasy. We examined the patient to evaluate whether analgesic idiosyncrasy might have been acquired by viral infection. Sulpyrine provocation testing was performed to confirm the patient's development of analgesic idiosyncrasy and methacholine provocation testing was performed to assess bronchial hyperresponsiveness. The titer of anti-HSV IgG antibody was measured to confirm viral infection. Sulpyrine provocation testing revealed that hypersensitivity to analgesics had appeared in this patient. In contrast, the marked improvement of her bronchial hyperresponsiveness was confirmed by a PC(20) methacholine of 0.63 mg/ml 1 week after sulpyrine provocation testing. The anti-HSV IgG antibody confirmed recent HSV infection. To the best of our knowledge, this is the first reported case of acquired analgesic idiosyncrasy following HSV infection.
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ranking = 0.011821098332044
keywords = herpes
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6/33. Human herpesvirus 6 encephalitis associated with hypersensitivity syndrome.

    Hypersensitivity syndrome, a serious systematic reaction to a limited number of drugs, is associated with the reactivation of human herpesvirus 6. A 56-year-old man developed acute limbic encephalitis followed by multiple organ failure during the course of toxic dermatitis induced by aromatic anticonvulsants. The clinical features of skin eruptions, high fever, eosinophilia, and atypical lymphocytosis were compatible with drug hypersensitivity syndrome. The patient showed seroconversion for human herpesvirus 6, and polymerase chain reaction detected human herpesvirus 6 dna in the cerebrospinal fluid. To our knowledge, this is the first report of human herpesvirus 6 encephalitis associated with hypersensitivity syndrome.
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ranking = 50.439493388342
keywords = human herpesvirus, herpesvirus, encephalitis, herpes
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7/33. A case of hypersensitivity syndrome due to phenytoin.

    We report a 30-year-old female with hypersensitivity syndrome (HS) due to phenytoin. Her disease course was typical with elevation of the antibody titer for human herpes virus 6. Three courses of methylpredonisolone pulse therapy were required to control the disease activity. Since the pathogenic mechanism and treatments for HS have not been established, further clinical analyses are warranted.
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ranking = 0.011821098332044
keywords = herpes
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8/33. Salazosulfapyridine induced hypersensitivity syndrome associated with reactivation of humanherpes virus 6.

    A 22-year-old woman with ulcerative colitis developed skin eruptions, liver dysfunction, and atypical lymphocytes in the peripheral blood two weeks after she started taking salazosulfapyridine (SASP). skin eruptions and liver damage were severe. Drug-induced lymphocyte stimulation test (DLST) for SASP was positive. She was diagnosed as having SASP-induced hypersensitivity syndrome (HS). Corticosteroid therapy was needed to suppress these reactions. The transient elevation of HHV-6 IgG titer paralleled the symptoms, which indicated that these reactions were associated with the reactivation of HHV-6. We suggest that HHV-6 IgG titer is one of the modalities for the diagnosis and the prediction of the clinical course of HS.
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ranking = 0.047284393328175
keywords = herpes
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9/33. Human herpes virus 6 encephalitis in allopurinol-induced hypersensitivity syndrome.

    Hypersensitivity syndrome is one of the most severe forms of drug eruption, and is characterized by a severe, potentially lethal, multiorgan involvement. Recently, reactivation of human herpesvirus 6 (HHV-6) has been suggested to be involved in this syndrome, although the exact role of HHV-6 remains elusive. In addition to exanthem subitum, neurological illnesses, such as infantile febrile illness without rash and encephalitis in immunocompromised patients have been attributed to HHV-6. A 51-year-old man developed a generalized erythematous eruption during treatment with allopurinol. prednisolone improved his condition, but after the dose of prednisolone was reduced neurological abnormalities such as mental deterioration and positive meningeal signs developed. HHV-6 dna in his blood by PCR analysis was positive. Furthermore, we detected HHV-6 dna in the cerebrospinal fluid. The titers of anti-HHV-6-IgG increased during the course. His neurological symptoms gradually improved and no neurological sequelae were noted. Neurological abnormalities associated with hypersensitivity syndrome are very rare. However, the detection of HHV-6 dna in the cerebrospinal fluid strongly indicates an involvement of reactivated HHV-6 in encephalitis.
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ranking = 11.8477368498
keywords = human herpesvirus, herpesvirus, encephalitis, herpes
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10/33. Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection.

    association of drug-induced hypersensitivity syndrome with viral infection is debated. Human herpesvirus 6 (HHV-6) reactivation has been the most frequently reported infection associated with this syndrome. However, a case of cytomegalovirus (CMV) infection was recently described associated with anticonvulsant-induced hypersensitivity syndrome. We report a case of severe allopurinol-induced hypersensitivity syndrome with pancreatitis associated with Epstein-Barr virus (EBV) infection. Active EBV infection was demonstrated in two consecutive serum samples by the presence of anti-EBV early antigen (EA) IgM antibodies and an increase in anti-EBV EA IgG antibodies, whereas no anti-EBV nuclear antigen IgG antibodies were detected. EBV dna was detected by polymerase chain reaction (PCR) in peripheral blood mononuclear cells. Reactivation of HHV-6 was suggested only by the presence of anti-HHV-6 IgM antibodies, but HHV-6 dna was not detected by PCR in the serum. Other viral investigations showed previous infection (CMV, rubella, measles, parvovirus B19), immunization after vaccination (hepatitis b virus), or absence of previous infection (hepatitis c virus, human immunodeficiency virus). We suggest that EBV infection may participate in some cases, as do the other herpesviruses HHV-6 or CMV, in the development of drug-induced hypersensitivity syndrome.
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ranking = 2
keywords = herpesvirus, herpes
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