CEM サイボウ デ A23187 ニ ヨッテ ヒキオコサレル ネクローシスヨウ ノ プログラム サイボウシ ワ ミトコンドリア ノ キノウ ショウガイ ニ カンケイシテイル

京都大学0048新制・論文博士博士(医学)乙第11812号論医博第1895号新制||医||927(附属図書館)24354UT51-2006-J509京都大学大学院医学研究科内科系専攻(主査)教授 鍋島 陽一, 教授 上杉 志成, 教授 清水 章学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDA

A Case of Drug-Induced Hypersensitivity Syndrome-Like Symptoms Following HHV-6 Encephalopathy

Background: Drug-induced hypersensitivity syndrome (DIHS) is a rare but severe disorder due to a systemic hypersensitivity reaction. We report on a case with DIHS-like symptoms following human herpes virus 6 (HHV-6) infection complicated with encephalopathy. Case Summary: An 11-month-old girl suffered from a human herpes virus 6 (HHV-6) infection (exanthema subitum) complicated with encephalopathy. We treated the patient with continuous infusion of thiopental, assisted mechanical ventilation, methylprednisolone pulse therapy, and γ-globulin infusion therapy starting on the fifth day of the illness and started phenobarbital administration on the eleventh day. The patient developed a fever, systemic erythematous exanthema, lymphadenopathy, and eosinophilia two weeks after the start of phenobarbital administration. Steroid therapy, methylprednisolone (4 mg/kg/day) followed by oral prednisolone (1 mg/kg/day), was started on the 28th day and was tapered off on the 72nd day after admission. Serum anti-HHV-6 IgG antibody elevation and the presence of HHV-6 DNA in the peripheral blood detected by polymerase chain reaction (PCR) analysis suggested reactivation of HHV-6 after the primary infection of HHV-6. Lymphocyte transformation test for phenobarbital was positive three weeks after the DIHS crisis. Discussion: HHV-6 reactivation is a unique feature in DIHS. In general one develops DIHS accompanied by reactivation of HHV-6 which has been residing in the body since the initial infection (exanthema subitum) in early childhood. This is the first report of a patient with DIHS-like symptoms which developed immediately following the primary infection of HHV-6