Phenytoin
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Drug-induced hypersensitivity syndrome, herpes simplex virus skin ulcers and cytomegalovirus reactivation in an elderly patient: case report A 71-year-old man developed drug-induced hypersensitivity syndrome (DIHS) while receiving oral phenytoin [dosage not stated]; he also subsequently developed herpes simplex virus (HSV) skin ulcers and cytomegalovirus (CMV) reactivation [not all outcomes stated]. The man, who had epilepsy caused by a prior cerebral infarction, started receiving phenytoin, and developed fever and erythema over his body 6 weeks later. His eruption persisted over 2 weeks after phenytoin discontinuation. Tests revealed leucocytosis, eosinophilia and liver dysfunction, with ALT and AST levels of 334 mU/mL and 76 mU/mL, respectively. He was diagnosed with DIHS caused by phenytoin. The man received prednisolone, and his eruptions and laboratory findings improved; however, ulcers developed on his abdomen 44 days after the onset of the eruptions, and rapidly spread on his chest and thigh. Biopsy showed positive results for HSV, and PCR was positive for both HSV and CMV. Blood samples revealed the presence of CMV antigen, and elevated levels of anti-CMV IgG and anti-CMV IgM. The diagnosis of HSV skin ulcers in the course of DIHS with systemic CMV reactivation was made. Author comment: "He was diagnosed as drug-induced hypersensitivity syndrome (DIHS) caused by phenytoin. . . The diagnosis of HSV skin ulcers in the course of DIHS with systemic CMV reactivation was made." Morita M, et al. A case of drug-induced hypersensitivity syndrome with multiple skin ulceration caused by herpes simplex virus and cytomegalovirus reactivation. Journal of Dermatology 39 (Suppl. 1): 37-38, Jun 2012. Available from: URL: 803076583 http://dx.doi.org/10.1111/j.1346-8138.2012.01623.x [abstract] - Japan
0114-9954/10/1418-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 8 Sep 2012 No. 1418
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