The role of human herpesvirus-6, Epstein–Barr virus and cytomegalovirus infections in the etiopathogenesis of different types of cutaneous drug reactions.

BACKGROUND

Recently, it has been recognized that drug-induced hypersensitivity syndrome (DIHS) is associated with reactivation of human herpesvirus-6 (HHV-6), Epstein–Barr virus (EBV) and cytomegalovirus (CMV). However, whether those viruses have a role in the development of cutaneous drug reactions (CDRs) other than DIHS is not known.

OBJECTIVE

To investigate the role of HHV-6, EBV and CMV infections in the etiopathogenesis of different types of CDRs.

METHODS

Eighteen patients with diagnosis of CDR according to the clinical and histopathological findings were evaluated. Real-time polymerase chain reaction (PCR) was used for the detection of EBV, CMV, and HHV-6 DNA in lesional skin biopsy specimens; EBV and CMV DNA in serum samples; and HHV-6 DNA in peripheral blood mononuclear cells.

RESULTS

The genome of HHV-6 was detected only in the lesional skin of two patients with DIHS. Epstein–Barr virus and CMV DNA in the skin lesions, EBV and CMV genomes in the serum samples, and HHV-6 DNA in the peripheral blood mononuclear cells were negative in all patients.

LIMITATIONS

The patient population was small and did not include all types of CDRs. Also, we had only two patients with DIHS. We had not been able to measure the increase in anti-viral IgG titers in serial serum samples.

CONCLUSION

Epstein–Barr virus and CMV infections do not seem to have a role in the etiopathogenesis of CDRs including DIHS. The association between HHV-6 infection and CDRs is likely to be limited to DIHS.