Drug‐induced hypersensitivity syndrome associated with Epstein–Barr virus infection

• Published in: British journal of dermatology (1951) Vol. 148; no. 5; pp. 1032 - 1034
• Main Authors: Descamps, V., Mahe, E., Houhou, N., Abramowitz, L., Rozenberg, F., Ranger‐Rogez, S., Crickx, B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01.05.2003; Blackwell; Oxford University Press
• Subjects: Adult; allopurinol; Allopurinol - adverse effects; Antimetabolites - adverse effects; Biological and medical sciences; Drug Hypersensitivity - virology; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Herpesvirus 4, Human; Herpesvirus 6, Human - physiology; Human viral diseases; Humans; hypersensitivity syndrome; Infectious diseases; Male; Medical sciences; Miscellaneous; Pancreatitis - virology; Roseolovirus Infections - complications; Syndrome; Viral diseases; Virus Activation; Gammaherpesvirinae; Human; Drug; hypersensitivity syndrome; Toxicity; Herpesviridae; Allopurinol; Hypersensitivity; Epstein Barr virus; Virus; Case study; Infection; Association; Viral disease; Epstein-Barr virus
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1046/j.1365-2133.2003.05330.x

Summary Association of drug‐induced hypersensitivity syndrome with viral infection is debated. Human herpesvirus 6 (HHV‐6) reactivation has been the most frequently reported infection associated with this syndrome. However, a case of cytomegalovirus (CMV) infection was recently described associated with anticonvulsant‐induced hypersensitivity syndrome. We report a case of severe allopurinol‐induced hypersensitivity syndrome with pancreatitis associated with Epstein–Barr virus (EBV) infection. Active EBV infection was demonstrated in two consecutive serum samples by the presence of anti‐EBV early antigen (EA) IgM antibodies and an increase in anti‐EBV EA IgG antibodies, whereas no anti‐EBV nuclear antigen IgG antibodies were detected. EBV DNA was detected by polymerase chain reaction (PCR) in peripheral blood mononuclear cells. Reactivation of HHV‐6 was suggested only by the presence of anti‐HHV‐6 IgM antibodies, but HHV‐6 DNA was not detected by PCR in the serum. Other viral investigations showed previous infection (CMV, rubella, measles, parvovirus B19), immunization after vaccination (hepatitis B virus), or absence of previous infection (hepatitis C virus, human immunodeficiency virus). We suggest that EBV infection may participate in some cases, as do the other herpesviruses HHV‐6 or CMV, in the development of drug‐induced hypersensitivity syndrome.