Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Linko and Keelung, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
J Dermatol. 2021 Jan;48(1):92-95. doi: 10.1111/1346-8138.15562. Epub 2020 Nov 12.
Drug-induced hypersensitivity syndrome (DIHS) is a type of severe drug adverse reaction with high morbidity and mortality. DIHS patients have been reported to subsequently develop autoimmune disease, which may be followed by end-organ decompensation. We report a 47-year-old woman who presented with fever, generalized maculopapular eruption, facial edema and eosinophilia with liver function impairment after taking celecoxib and sulfasalazine for 1 month. The patient was diagnosed with definite DIHS. The patient was treated with immunosuppressants including systemic corticosteroid for approximately 1.5 years due to recurrent episodes. Reactivation of human herpesvirus 6 and possible reactivation of cytomegalovirus were detected. Generalized hypopigmentation of the skin and leukotrichia were noted 4 months after the onset of DIHS. Histopathological examination confirmed the diagnosis of vitiligo. Some spontaneous repigmentation was noted 4 years after DIHS without specific treatment. Further immunoserology study showed elevated plasma C-X-C motif chemokine 10 level, which is related to vitiligo activity, in our patient. The occurrence of widespread vitiligo after DIHS is an extremely rare condition. This case provides an important reminder for physicians to monitor such severe complications after DIHS.
药物诱导的超敏反应综合征（DIHS）是一种严重的药物不良反应，发病率和死亡率均较高。有报道称 DIHS 患者随后会发展为自身免疫性疾病，可能会导致终末器官失代偿。我们报告了 1 例 47 岁女性，因服用塞来昔布和柳氮磺胺吡啶 1 个月后出现发热、全身斑丘疹、面部水肿和嗜酸性粒细胞增多伴肝功能损害。患者被诊断为明确的 DIHS。由于反复发作，该患者接受了包括全身皮质类固醇在内的免疫抑制剂治疗约 1.5 年。检测到人类疱疹病毒 6 再激活和巨细胞病毒可能再激活。DIHS 发病后 4 个月，皮肤出现广泛性色素减退和白发。组织病理学检查证实了白癜风的诊断。DIHS 后 4 年，未经特殊治疗，部分皮肤出现自发性复色。进一步的免疫血清学研究显示，该患者血浆 C-X-C 基序趋化因子 10 水平升高，与白癜风的活动度有关。DIHS 后发生广泛白癜风的情况极为罕见。该病例提醒医生在 DIHS 后要监测此类严重并发症。
