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Severe graft‐versus‐host disease‐like enterocolitis accompanied with cytomegalovirus‐reactivation in drug‐induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms
- Source :
- The Journal of Dermatology. 49:796-799
- Publication Year :
- 2022
- Publisher :
- Wiley, 2022.
-
Abstract
- Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe drug adverse reaction with skin eruption and visceral organ involvement. The characteristic clinical features of DIHS/DRESS are reactivation of human herpesviruses (HHV) and the development of autoimmune diseases, but their pathogenesis and associations are not yet understood. Here, we report a 66-year-old man who presented with fever, generalized erythema, diffuse lymphadenopathy, and diarrhea after 3 weeks of treatment with zonisamide. Reactivation of HHV-6 and cytomegalovirus (CMV) was detected during the clinical course. The patient was diagnosed with DIHS/DRESS and treated with systemic prednisolone, i.v. immunoglobulin therapy, and ganciclovir. However, severe enterocolitis persisted for 6 months. A series of examinations revealed features of both CMV enterocolitis, as indicated by identification of a few CMV-positive cells on immunohistochemical analysis, and graft-versus-host disease (GVHD)-like enterocolitis indicated by orange-peel appearance on endoscopic examination and histopathological loss of goblet cells. Intractable enterocolitis continued and the patient finally died of pneumonia. An autoimmune predisposition in DIHS/DRESS patients in combination with CMV reactivation was considered to trigger the severe enterocolitis of this case that showed GVHD-like features of the gastrointestinal tract. GVHD-like organ damage is a pathological condition rarely observed in DIHS/DRESS but should be recognized as one of the most severe complications of the disease.
Details
- ISSN :
- 13468138 and 03852407
- Volume :
- 49
- Database :
- OpenAIRE
- Journal :
- The Journal of Dermatology
- Accession number :
- edsair.doi.dedup.....7cf824f234eb3d47350ac55a1f846ba4
- Full Text :
- https://doi.org/10.1111/1346-8138.16415