Human herpes virus 6 encephalitis in allopurinol-induced hypersensitivity syndrome

• Published in: Acta dermato-venereologica Vol. 83; no. 2; pp. 128 - 131
• Main Authors: MASAKI, Taro, FUKUNAGA, Atsushi, UEDA, Masato, TOHYAMA, Mikiko, KODA, Yoshiyuki, OKUDA, Shiho, MAEDA, Nobuya, KANDA, Fumio, YASUKAWA, Masaki, HASHIMOTO, Koji, HORIKAWA, Tatsuya
• Format: Journal Article
• Language: English
• Published: Uppsala Acta dermato-venereologica 2003
• Subjects: Allopurinol - adverse effects; Anti-Inflammatory Agents - adverse effects; Biological and medical sciences; Dose-Response Relationship, Drug; Drug Hypersensitivity - complications; Drug Hypersensitivity - drug therapy; Drug Hypersensitivity - etiology; Encephalitis, Herpes Simplex - complications; Gout Suppressants - adverse effects; Herpesvirus 6, Human - isolation & purification; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Middle Aged; Prednisolone - adverse effects; Recurrence; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Human; Encephalitis; Skin disease; Nervous system diseases; herpesvirus cerebrospinal fluid; Toxicity; Herpesviridae; Allopurinol; Hypersensitivity; Herpes; neurological symptoms; Cerebrospinal fluid; Cerebral disorder; Infection; Case study; Virus; Herpesvirus hominis 6; Association; Viral disease; Central nervous system disease
• ISSN: 0001-5555; 1651-2057
• DOI: 10.1080/00015550310007481

Hypersensitivity syndrome is one of the most severe forms of drug eruption, and is characterized by a severe, potentially lethal, multiorgan involvement. Recently, reactivation of human herpesvirus 6 (HHV-6) has been suggested to be involved in this syndrome, although the exact role of HHV-6 remains elusive. In addition to exanthem subitum, neurological illnesses, such as infantile febrile illness without rash and encephalitis in immunocompromised patients have been attributed to HHV-6. A 51-year-old man developed a generalized erythematous eruption during treatment with allopurinol. Prednisolone improved his condition, but after the dose of prednisolone was reduced neurological abnormalities such as mental deterioration and positive meningeal signs developed. HHV-6 DNA in his blood by PCR analysis was positive. Furthermore, we detected HHV-6 DNA in the cerebrospinal fluid. The titers of anti-HHV-6-IgG increased during the course. His neurological symptoms gradually improved and no neurological sequelae were noted. Neurological abnormalities associated with hypersensitivity syndrome are very rare. However, the detection of HHV-6 DNA in the cerebrospinal fluid strongly indicates an involvement of reactivated HHV-6 in encephalitis.