PMID- 33504758
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1941-5923 (Electronic)
IS  - 1941-5923 (Linking)
VI  - 22
DP  - 2021 Jan 28
TI  - A 51-Year-Old Woman with Drug-Induced Hypersensitivity Syndrome Associated with 
      Carbamazepine, Reactivation of Human Herpesvirus 6, and Acute Liver Failure: A 
      Case Report.
PG  - e928587
LID - 10.12659/AJCR.928587 [doi]
AB  - BACKGROUND Infection with human herpesvirus 6 (HHV-6) is a recognized risk factor 
      for the development of drug-induced hypersensitivity syndrome (DIHS). DIHS is a 
      systemic autoimmune condition that presents with mucocutaneous lesions of varying 
      severity and comprises 3 subtypes: toxic epidermal necrolysis, Stevens-Johnson 
      syndrome, and drug reaction with eosinophilia and systemic symptoms (DRESS). 
      Here, we describe the case of a 51-year-old woman with a diagnosis of DIHS 
      associated with carbamazepine, reactivation of HHV-6, and acute liver failure, 
      which was consistent with DRESS. CASE REPORT We present the case of a 51-year-old 
      Japanese woman who had been taking carbamazepine for epilepsy for the past 3 
      weeks. She presented with a fever, liver dysfunction, eosinophilia, and the 
      sudden appearance of a skin rash. Steroid therapy was started for suspected 
      drug-induced liver injury. The skin eruption disappeared, and liver dysfunction 
      showed an improving trend. However, after stopping steroid, the pyrexia and 
      eosinophilia reappeared. Therefore, prednisolone was re-administrated. HHV-6 DNA 
      was detected, so HHV-6 reactivation was confirmed. Carbamazepine was stopped, and 
      the clinical manifestations improved. She was ultimately diagnosed with DIHS, 
      consistent with DRESS, associated with carbamazepine and HHV-6 reactivation, and 
      liver dysfunction was assessed histologically. Therefore, the drug-related 
      hepatotoxicity of carbamazepine played a role in causing liver damage rather than 
      HHV-6 infection at that time. CONCLUSIONS We describe a case of DIHS that was 
      also associated with acute liver failure, consistent with DRESS. The case 
      highlights the importance of making the correct diagnosis, as well as the 
      management of mucocutaneous lesions and other systemic conditions (including 
      acute liver failure).
FAU - Miyasaka, Akio
AU  - Miyasaka A
AD  - Division of Hepatology, Department of Internal Medicine, Iwate Medical University 
      School of Medicine, Shiwa, Iwate, Japan.
FAU - Kumagai, Ichiro
AU  - Kumagai I
AD  - Department of Gastroenterology, Morioka City Hospital, Morioka, Iwate, Japan.
FAU - Masuda, Tomoyuki
AU  - Masuda T
AD  - Department of Pathology, Iwate Medical University School of Medicine, Shiwa, 
      Iwate, Japan.
FAU - Takikawa, Yasuhiro
AU  - Takikawa Y
AD  - Division of Hepatology, Department of Internal Medicine, Iwate Medical University 
      School of Medicine, Shiwa, Iwate, Japan.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20210128
PL  - United States
TA  - Am J Case Rep
JT  - The American journal of case reports
JID - 101489566
RN  - 0 (Pharmaceutical Preparations)
RN  - 33CM23913M (Carbamazepine)
SB  - IM
MH  - Carbamazepine/adverse effects
MH  - *Drug Hypersensitivity Syndrome/diagnosis/etiology
MH  - Female
MH  - *Herpesvirus 6, Human
MH  - Humans
MH  - *Liver Failure, Acute/chemically induced
MH  - Middle Aged
MH  - *Pharmaceutical Preparations
PMC - PMC7851717
COIS- Conflict of interest: None declared Conflicts of interest None.
EDAT- 2021/01/29 06:00
MHDA- 2021/05/15 06:00
PMCR- 2021/01/28
CRDT- 2021/01/28 05:34
PHST- 2021/01/28 05:34 [entrez]
PHST- 2021/01/29 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2021/01/28 00:00 [pmc-release]
AID - 928587 [pii]
AID - 10.12659/AJCR.928587 [doi]
PST - epublish
SO  - Am J Case Rep. 2021 Jan 28;22:e928587. doi: 10.12659/AJCR.928587.