PMID- 24749495
OWN - NLM
STAT- MEDLINE
DCOM- 20141229
LR  - 20211021
IS  - 1398-9995 (Electronic)
IS  - 0105-4538 (Print)
IS  - 0105-4538 (Linking)
VI  - 69
IP  - 6
DP  - 2014 Jun
TI  - The dynamics of herpesvirus reactivations during and after severe drug eruptions: 
      their relation to the clinical phenotype and therapeutic outcome.
PG  - 798-805
LID - 10.1111/all.12410 [doi]
AB  - BACKGROUND: Drug-induced hypersensitivity syndrome/drug rash with eosinophilia 
      and systemic symptoms (DIHS/DRESS) and Stevens-Johnson syndrome (SJS)/toxic 
      epidermal necrolysis (TEN) represent contrasting poles of severe drug eruptions, 
      and sequential reactivations of several herpesviruses have exclusively been 
      demonstrated in the former. No previous studies, however, were extended beyond 
      the acute stage. We sought to investigate whether herpesvirus reactivations could 
      also be observed in SJS/TEN and beyond the acute stage of both diseases. METHODS: 
      Patients with SJS (n = 16), SJS/TEN overlap (n = 2), TEN (n = 10), and DIHS/DRESS 
      (n = 34) were enrolled. We performed a retrospective analysis of Epstein-Barr 
      virus (EBV), human herpesvirus 6 (HHV-6), and cytomegalovirus (CMV) DNA loads 
      sequentially determined by real-time polymerase chain reaction during a 2-year 
      period after onset. RESULTS: Persistently increased EBV loads were detected in 
      SJS during the acute stage and long after resolution, but not in others. In 
      contrast, high HHV-6 loads were exclusively detected in DIHS/DRESS during the 
      acute stage. The dynamics of herpesvirus reactivation varied in DIHS/DRESS 
      according to the use of systemic corticosteroids: While EBV loads were higher in 
      patients not receiving systemic corticosteroids, CMV and HHV-6 loads were higher 
      in those receiving them. CONCLUSIONS: Distinct patterns of herpesvirus 
      reactivation according to the pathological phenotype and to the use of systemic 
      corticosteroids were observed during the acute stage and follow-up period, which 
      may contribute, at least in part, to the difference in the clinical 
      manifestations and long-term outcomes. Systemic corticosteroids during the acute 
      stage may improve the outcomes in DIHS/DRESS.
CI  - (c) 2014 The Authors. Allergy Published by John Wiley & Sons Ltd.
FAU - Ishida, T
AU  - Ishida T
AD  - Department of Dermatology, Kyorin University School of Medicine, Mitaka, Tokyo, 
      Japan.
FAU - Kano, Y
AU  - Kano Y
FAU - Mizukawa, Y
AU  - Mizukawa Y
FAU - Shiohara, T
AU  - Shiohara T
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140417
PL  - Denmark
TA  - Allergy
JT  - Allergy
JID - 7804028
RN  - 0 (DNA, Viral)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - DNA, Viral
MH  - Drug Eruptions/*complications/diagnosis/drug therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Herpesviridae/drug effects/*genetics
MH  - Herpesviridae Infections/*complications/*virology
MH  - Humans
MH  - Immunosuppressive Agents/pharmacology/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care
MH  - Phenotype
MH  - Retrospective Studies
MH  - Stevens-Johnson Syndrome/complications/diagnosis
MH  - Time Factors
MH  - Viral Load
MH  - *Virus Activation/drug effects
PMC - PMC4112819
OTO - NOTNLM
OT  - Epstein-Barr virus
OT  - Stevens-Johnson syndrome/toxic epidermal necrolysis
OT  - cytomegalovirus
OT  - drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic 
      symptoms
OT  - human herpesvirus 6
EDAT- 2014/04/23 06:00
MHDA- 2014/12/30 06:00
CRDT- 2014/04/23 06:00
PHST- 2014/03/06 00:00 [accepted]
PHST- 2014/04/23 06:00 [entrez]
PHST- 2014/04/23 06:00 [pubmed]
PHST- 2014/12/30 06:00 [medline]
AID - ALL12410 [pii]
AID - 10.1111/all.12410 [doi]
PST - ppublish
SO  - Allergy. 2014 Jun;69(6):798-805. doi: 10.1111/all.12410. Epub 2014 Apr 17.