Influence of corticosteroid therapy on viral reactivation in drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms.
Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction characteristically associated with sequential reactivation of herpesviruses, such as human herpesvirus 6 (HHV-6), Epstein-Barr virus (EBV), and cytomegalovirus (CMV). Since systemic corticosteroids are thought to result in viral reactivation due to their immunosuppressive effects, we clarified the influence of systemic corticosteroid therapy on viral reactivation in DIHS/DRESS. Viral DNA in peripheral whole blood and serum sIL-2R level were measured during the disease course in twenty DIHS/DRESS patients. Six of seven patients treated without corticosteroids experienced HHV-6 viremia associated with elevated serum sIL-2R levels. In contrast, high-dose corticosteroids started within 1 week after onset tended to inhibit the occurrence of HHV-6 reactivation with remarkable suppression of serum sIL-2R level. Low-dose corticosteroids or late-start high-dose corticosteroids did not suppress occurrence of HHV-6 viremia and the increase of sIL-2R levels. HHV-6 load in the blood was clearly correlated with the serum sIL-2R level. On the other hand, increased CMV load were found in patients treated with corticosteroids regardless of the start time. The frequency of detection of EBV DNA in peripheral blood was similarly observed in all groups. In conclusion, high-dose corticosteroids started within 1 week tended to suppress HHV-6 reactivation through suppression of T cell activation. However, CMV proliferation was promoted by corticosteroids regardless of the start time. These observations suggested that careful consideration should be given to the dose and timing of administration of systemic corticosteroids in the treatment of DIHS/DRESS.
['Tohyama|Mikiko|M|https://orcid.org/0000-0003-4756-0155', 'Hashimoto|Koji|K|', 'Oda|Fumiko|F|', 'Namba|Chika|C|https://orcid.org/0000-0002-6307-9516', 'Sayama|Koji|K|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D003587:Cytomegalovirus D004279:DNA, Viral D004305:Dose-Response Relationship, Drug D004334:Drug Administration Schedule D063926:Drug Hypersensitivity Syndrome D005260:Female D005938:Glucocorticoids D006566:Herpesviridae Infections D004854:Herpesvirus 4, Human D015654:Herpesvirus 6, Human D006801:Humans D007166:Immunosuppressive Agents D008297:Male D008875:Middle Aged D012720:Severity of Illness Index D014775:Virus Activation D055815:Young Adult
drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms human herpesvirus 6 cytomegalovirus systemic corticosteroid soluble interleukin-2 receptor