Department of Dermatology, Showa University School of Medicine, Tokyo, Japan.
Department of Dermatology, Nara Medical University School of Medicine, Nara, Japan.
J Dermatol. 2019 Mar;46(3):226-233. doi: 10.1111/1346-8138.14776. Epub 2019 Jan 21.
Drug-induced hypersensitivity syndrome (DIHS), also referred to as drug reaction with eosinophilia and systemic symptoms (DRESS), is a multi-organ systemic drug reaction characterized by hematological abnormalities and reactivation of human herpesvirus-6 (HHV-6). DIHS/DRESS is typically associated with a limited number of drugs, such as the anticonvulsants. Our group has treated 12 patients for DIHS/DRESS due to lamotrigine (LTG), but their presentation differed from that of patients with DIHS/DRESS caused by other drugs. The aim of the present study was to identify significant differences between DIHS/DRESS caused by LTG versus other drugs. We retrospectively reviewed data of 12 patients with DIHS/DRESS caused by LTG and 32 patients with DIHS/DRESS due to other drugs. The increase in alanine aminotransferase level was significantly milder in the LTG group than the DIHS/DRESS group due to other drugs. The percentage of atypical lymphocytes in the blood during DIHS/DRESS was lower in the LTG group. Serum levels of lactate dehydrogenase and thymus and activation-regulated chemokine were also lower in the LTG group. There were fewer DIHS/DRESS patients with HHV-6 reactivation in the LTG group than in the group treated with other drugs. Lymphocyte transformation after DIHS/DRESS onset was faster in the LTG group. The two groups did not differ with respect to the interval from first drug intake to rash, white blood cell count, blood eosinophilia or DRESS score. There were no significant histopathological differences between the two groups. The features of LTG-associated DIHS/DRESS and DIHS/DRESS due to other drugs differ.
药物诱导的超敏反应综合征（DIHS），也称为药物反应伴嗜酸性粒细胞增多和全身症状（DRESS），是一种多器官系统药物反应，其特征为血液学异常和人类疱疹病毒-6（HHV-6）再激活。DIHS/DRESS 通常与少数几种药物相关，如抗惊厥药。我们的团队治疗了 12 例因拉莫三嗪（LTG）引起的 DIHS/DRESS 患者，但他们的表现与其他药物引起的 DIHS/DRESS 患者不同。本研究旨在确定 LTG 引起的 DIHS/DRESS 与其他药物引起的 DIHS/DRESS 之间的显著差异。我们回顾性分析了 12 例因 LTG 引起的 DIHS/DRESS 患者和 32 例因其他药物引起的 DIHS/DRESS 患者的数据。与其他药物引起的 DIHS/DRESS 相比，LTG 组丙氨酸氨基转移酶水平升高明显较轻。在 DIHS/DRESS 期间，LTG 组血液中的非典型淋巴细胞百分比较低。LTG 组血清乳酸脱氢酶和胸腺激活调节趋化因子水平也较低。LTG 组 HHV-6 再激活的 DIHS/DRESS 患者较少。LTG 组 DIHS/DRESS 发病后淋巴细胞转化更快。两组间从首次服药到皮疹、白细胞计数、血嗜酸性粒细胞增多或 DRESS 评分的时间间隔无差异。两组间无明显的组织病理学差异。LTG 相关的 DIHS/DRESS 和其他药物引起的 DIHS/DRESS 的特征不同。
