sulfasalazine hypersensitivity syndrome

Yamanishi Carrigan  SRBertovich The clinical features of hypersensitivity syndrome are similar to those of infectious mononucleosis. Human herpesvirus 6 infection in renal transplantation.  MRThomson Medium-to-long-term follow-up is required even after complete resolution of the condition. Severe Hypersensitivity Syndrome Due to Sulfasalazine Associated With Reactivation of Human Herpesvirus 6.  FJKalser Prednisolone, 40 mg/d, was continued and tapered with improvement of clinical symptoms. Han See rights and permissions. IgG antibody to HHV-6 was determined using the indirect immunofluorescent antibody assay described previously.11 Mononuclear cells infected with HHV-6 (HST strain) were used as a target antigen.  KShiraki Arch Dermatol. The lavage specimen showed a … Therefore, the adverse drug reaction causing hypersensitivity syndrome requires additional factors. Fulminant hepatitis in primary human herpesvirus-6 infection.  DLennette  SFOnions No serologic evidence of viral infections has been reported with this syndrome; however, human herpesvirus 6 infection has not been specifically investigated, which could cause an infectious mononucleosislike syndrome. Terms of Use| Sulfonamide antimicrobials are commonly reported as causing drug allergy and have been implicated in a variety of hypersensitivity reactions including immediate IgE-mediated reactions, benign T-cell-mediated rashes, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. These drugs have a variety of uses and can be classified into antibiotics and non-antibiotic drugs. Here, we report the first case, to our knowledge, of a patient with previously unidentified SIHS who developed a significantly more rapid and extreme recurrence on re-exposure to sulfasalazine. A generalized maculopapular rash was observed over the patient's face, trunk, and extremities (Figure 1). We report 2 cases of sulfasalazine-induced severe hypersensitivity syndrome associated with the reactivation of HHV-6. Treatment with 60 mg/d of oral prednisolone was begun on the patient's ninth day at the hospital and tapered with improvement of clinical symptoms. We describe a new case of sulfasalazine-induced hypersensitivity syndrome associated with HHV-6 reactivation and the induction of anticardiolipin and anti-thyroid peroxidase antibodies. Kanner Detection of human herpesvirus 6 in plasma of children with primary infection and immunosuppressed patients by polymerase chain reaction. Isolation of a new virus, HBLV, in patients with lymphoproliferative disorders.  BKKalow Accessibility Statement. Peripheral blood mononuclear cells (PBMCs) were separated and cultured with umbilical cord blood mononuclear cells as described previously.8 The cytopathic effect of HHV-6 was examined with an inverted microscope. Clinical signs included a maculopapular rash progressing to exfoliative erythroderma, fever, and lymphadenopathy. Systemic corticosteroid therapy generally improves the condition. Edema of the face was also present. Recently, a severe infectious mononucleosislike syndrome caused by HHV-6 infection was reported in immunocompetent adults.5-7 Clinical signs included high fever, skin rash, generalized lymphadenopathy, liver dysfunction, and leukocytosis with the appearance of atypical lymphocytes.  RSTedesco Azulfidine (sulfasalazine) is an anti-inflammatory medication used to treat mild to severe ulcerative colitis and rheumatoid arthritis. A marked increase in anti–HHV-6 IgG titers strongly indicates a primary or reactivated infection of HHV-6. It seems likely that the reactivation of HHV-6 is specific to hypersensitivity syndrome. Please enable it to take advantage of the complete set of features! Gopal Oral sulfasalazine inhibits the absorption and metabolism of folic acid and may cause folic acid deficiency, potentially resulting in serious blood disorders (e.g. Severe infectious mononucleosis-like syndrome and primary human herpesvirus 6 infection in an adult. Human herpesvirus-6 infection in bone marrow transplantation. We would like to suggest possible treatment with an antiviral drug such as ganciclovir for hypersensitivity syndrome, since our observations indicate that HHV-6 infection occurs in a late stage of hypersensitivity syndrome.31.  DALaurent Human herpesvirus 6 has been identified as the cause of exanthem subitum.14 Most people are infected with HHV-6 in early childhood. Methods: PBMC from 2 patients with severe hypersensitivity syndrome to sulfasalazine, 3 patients with sulfamethoxazole allergy and 5 healthy donors were isolated and incubated with medium only (negative control), 2 concentrations (10, 100 μg/ml) of sulfapyridine, 2 concentrations (100, 200 μg/ml) of sulfamethoxazole, and tetanus toxoid (10 μg/ml) as a positive control. Keywords: DRESS typically develops three weeks to three months after starting treatment with the precipitating drug. We suggest that HHV-6 infection may be a required cause of hypersensitivity syndrome. She did recover completely without any further recurrence to date, after definitively discontinuing sulfasalazine.  SMukai Callot  PCarrigan Seroconversion to human herpesvirus 6 following liver transplantation is a marker of cytomegalovirus disease. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. This observation suggests active replication of the virus after the initiation of clinical symptoms. A drug-associated hypersensitivity syndrome has been reported with administration of sulfasalazine, anticonvulsants, dapsone, allopurinol, and several other medications.1-4,12,13 Its clinical features resemble those of infectious mononucleosis and appear 2 to 5 weeks after administration of the drugs.  SPGrant  MEizuru Leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance were also observed. In 2 patients, we tried to isolate HHV-6 from cultured PBMCs; however, the virus was not detected. Secchiero  PD It is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not Facial edema was also present. Serum samples from the patients were stored at −80°C until use. Keywords: Drug hypersensitivity, enzyme-linked immunospot assay, sulfasalazine Clipboard, Search History, and several other advanced features are temporarily unavailable. The clinical features of the syndrome appeared 18 and 32 days after administration of sulfasalazine.  Y A case of human herpesvirus-6 lymphadenitis with infectious mononucleosis-like syndrome. Associated rash usually progressed to desquamation. Common side effects of Azulfidine include gastrointestinal disturbances, headache, allergic reactions, rash when exposed to sunlight, and changes in skin or urine color.  MStenson The patient is a 58-year-old woman with asymptomatic Crohn's disease who, 10 days after initiating sulfasalazine, developed fevers, diffuse rash, pancytopenia, hypotension and hepatitis without a definitive source of infection. Tohyama M, Yahata Y, Yasukawa M, et al.  WF Inhibition of antibody secretion by 5-aminosalicylic acid. M indicates the molecular weight standard marker; P, positive control; and N, umbilical cord-blood mononuclear cells (negative control). However, 1 of the 3 patients described by Sumiyoshi et al6 had been treated with phenobarbital for 3 weeks prior to onset of the illness, and peripheral blood eosinophilia had been found on admission (Y. Sumiyoshi, written communication, June 1997). Dress ) syndrome and the patient findings support the relevance of HHV-6 is specific to hypersensitivity induced. A putative immediate-early region of human herpesvirus-6 infection after marrow transplantation with all medications except ketotifen was!, rubella, adenovirus, and isolation of HHV-6 from cultured PBMCs ; however, the clinical symptoms take of... Precipitating drug predisposing to idiosyncratic toxicity a marked increase in anti–HHV-6 IgG titers was observed over the was! ( the acronym for drug rash with Eosinophilia and systemic symptoms ) is a painful joint disease al27 have drug-induced! 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