Funck-Brentano E, Duong T, Family D, Bouaziz J-D, Ortonne N, Bagot M, Roujeau J-C, Wolkenstein P, Valeyrie-Allanore L
Service de dermatologie, hôpital Henri-Mondor, université Paris XII, centre de référence des maladies bulleuses immunologiques et toxiques, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France.
Ann Dermatol Venereol. 2011 Aug-Sep;138(8-9):580-5. doi: 10.1016/j.annder.2011.01.048. Epub 2011 Mar 21.
DRESS syndrome is a severe adverse drug reaction with visceral involvement. Its physiopathology includes immunological disorders associated with human herpes virus (HHV) reactivation. We report two cases of auto-immune thyroiditis occurring in the context of DRESS syndrome associated with HHV-6 reactivation.
Case 1 : A 39-year-old woman presented DRESS syndrome with HHV-6 reactivation, cutaneous, lymph node, hepatic and renal disorders treated with systemic corticosteroids for 10 months. Following discontinuation of the corticosteroids, she developed Graves's disease, which was stabilized with carbimazole and a beta-blocker. CASE 2: A 31-year-old woman was hospitalized for DRESS syndrome with delayed HHV-6 reactivation and severe hepatic involvement. She was successfully treated by topical steroids. Six weeks later, she presented De Quervain thyroiditis associated with moderate relapsing DRESS, which were treated by sodium levothyroxine and topical steroids.
There is currently debate about the implication of viral reactivation, in particular HHV-6, in chronic DRESS, relapse and development of auto-immune diseases. These observations highlight the potential risk of patients developing auto-immune diseases and underline the need for prolonged clinical and laboratory follow-up of patients with DRESS.
药物超敏反应伴嗜酸性粒细胞增多和系统症状（DRESS）综合征是一种伴有内脏受累的严重药物不良反应。其病理生理学包括与人类疱疹病毒（HHV）再激活相关的免疫紊乱。我们报告两例在与HHV-6再激活相关的DRESS综合征背景下发生的自身免疫性甲状腺炎病例。
病例1：一名39岁女性出现伴有HHV-6再激活的DRESS综合征，有皮肤、淋巴结、肝脏和肾脏病变，接受全身皮质类固醇治疗10个月。停用皮质类固醇后，她患上了格雷夫斯病，通过卡比马唑和β受体阻滞剂得以稳定病情。病例2：一名31岁女性因伴有延迟HHV-6再激活和严重肝脏受累的DRESS综合征住院。她通过局部类固醇治疗成功康复。六周后，她出现了与中度复发性DRESS相关的亚急性甲状腺炎，通过左甲状腺素钠和局部类固醇进行治疗。
目前关于病毒再激活，尤其是HHV-6，在慢性DRESS、复发及自身免疫性疾病发展中的作用存在争议。这些观察结果突出了患者发生自身免疫性疾病的潜在风险，并强调了对DRESS患者进行长期临床和实验室随访的必要性。
