Reactions 1460, p15 - 13 Jul 2013 S Carbamazepine Drug-induced hypersensitivity syndrome with lymphadenopathy and human herpesvirus 6 reactivation: case report A 57-year-old woman developed drug-induced hypersensitivity syndrome with lymphadenopathy and human herpesvirus 6 (HHV-6) reactivation while receiving carbamazepine. The woman, who had bipolar disorder, presented with a history of generalised erythema of her face and trunk, persistent pyrexia, a morbilliform eruption of 1 week’s duration and a sore throat of 3 weeks’ duration. One month before presentation, she had started carbamazepine (day 1) [dosage and route not stated; indication not clearly stated]. On day 34, examination revealed mild periorbital oedema and progression of erythema. She was tentatively diagnosed with a cutaneous reaction to carbamazepine. Carbamazepine was withdrawn, and the woman received prednisolone. One week later, her sore throat and fever had almost resolved while her cutaneous lesions had improved. She developed generalised lymphadenopathy, and she presented on day 43. Tests revealed an elevated WBC count, and elevated LDH, soluble interleukin 2 receptor and serum hepatic biliary enzyme levels. On day 48 she was admitted with suspected malignant lymphoma. Lymph node biopsy revealed enlarged T zones with pleomorphic infiltration. Three weeks after carbamazepine withdrawal, lymphadenopathy resolved spontaneously. Tests revealed positive HHV-6 in Reed-Sternberg-like cells and an elevated HHV-7 IgG antibody level on day 49. PCR of HHV-6 genomes in lymph node tissues suggests aberrant propagation. She was diagnosed with drug- induced hypersensitivity syndrome. Author comment: "[T]he patients was diagnosed with drug-induced hypersensitivity syndrome (DIHS), satisfying all of the criteria for DIHS proposed by a Japanese severe cutaneous adverse reaction group, which includes HHV-6 reactivation." Saraya T, et al. Evidence for reactivation of human herpesvirus 6 in generalized lymphadenopathy in a patient with drug-induced hypersensitivity syndrome. Journal of Clinical Microbiology 51: 1979-1982, No. 6, Jun 2013. Available from: URL: http://dx.doi.org/10.1128/JCM.00097-13 - Japan 803089871 1 Reactions 13 Jul 2013 No. 1460 0114-9954/13/1460-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved

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Reactions 1460, p15 - 13 Jul 2013

SCarbamazepine

Drug-induced hypersensitivity syndrome withlymphadenopathy and human herpesvirus 6reactivation: case report

A 57-year-old woman developed drug-inducedhypersensitivity syndrome with lymphadenopathy and humanherpesvirus 6 (HHV-6) reactivation while receivingcarbamazepine.

The woman, who had bipolar disorder, presented with ahistory of generalised erythema of her face and trunk,persistent pyrexia, a morbilliform eruption of 1 week’sduration and a sore throat of 3 weeks’ duration. One monthbefore presentation, she had started carbamazepine (day 1)[dosage and route not stated; indication not clearly stated]. Onday 34, examination revealed mild periorbital oedema andprogression of erythema. She was tentatively diagnosed with acutaneous reaction to carbamazepine.

Carbamazepine was withdrawn, and the woman receivedprednisolone. One week later, her sore throat and fever hadalmost resolved while her cutaneous lesions had improved.She developed generalised lymphadenopathy, and shepresented on day 43. Tests revealed an elevated WBC count,and elevated LDH, soluble interleukin 2 receptor and serumhepatic biliary enzyme levels. On day 48 she was admittedwith suspected malignant lymphoma. Lymph node biopsyrevealed enlarged T zones with pleomorphic infiltration. Threeweeks after carbamazepine withdrawal, lymphadenopathyresolved spontaneously. Tests revealed positive HHV-6 inReed-Sternberg-like cells and an elevated HHV-7 IgG antibodylevel on day 49. PCR of HHV-6 genomes in lymph node tissuessuggests aberrant propagation. She was diagnosed with drug-induced hypersensitivity syndrome.

Author comment: "[T]he patients was diagnosed withdrug-induced hypersensitivity syndrome (DIHS), satisfying allof the criteria for DIHS proposed by a Japanese severecutaneous adverse reaction group, which includes HHV-6reactivation."Saraya T, et al. Evidence for reactivation of human herpesvirus 6 in generalizedlymphadenopathy in a patient with drug-induced hypersensitivity syndrome.Journal of Clinical Microbiology 51: 1979-1982, No. 6, Jun 2013. Available from:URL: http://dx.doi.org/10.1128/JCM.00097-13 - Japan 803089871