Bajoriuniene Ieva, Musteikiene Greta, Ramonaite Agne, Sitkauskiene Brigita
Department of Immunology and Allergology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Pulmonology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Cent Eur J Immunol. 2021;46(3):401-404. doi: 10.5114/ceji.2021.109670. Epub 2021 Oct 19.
Drug-induced hypersensitivity syndrome (DiHS) or drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe adverse drug-induced reaction characterized by various symptoms: skin rash, fever, lymph node enlargement and internal organ involvement, which starts within 2 weeks to 3 months after drug initiation. It is challenging to diagnose this syndrome due to the variety of cutaneous and visceral symptoms. Different mechanisms have been implicated in its development, including genetic susceptibility associated with human leucocyte antigen (HLA) loci, detoxification defects leading to reactive metabolite formation and subsequent immunological reactions, slow acetylation, and reactivation of human herpes, including Epstein-Barr virus and human herpes virus (HHV)-6 and HHV-7. The most frequently reported causes of DiHS/DRESS are antiepileptic agents, allopurinol and sulfonamides. We report a case of DiHS/DRESS induced by second-line treatment for tuberculosis, prothionamide and para-aminosalicylic acid, and Epstein-Barr virus re-infection. Patch testing, which was performed in this case, is not fully standardized, but it can be helpful and a safe way to evaluate and diagnose DiHS/DRESS.
药物性超敏反应综合征（DiHS）或伴有嗜酸性粒细胞增多和全身症状的药物反应（DRESS）综合征是一种严重的药物不良反应，其特征为多种症状：皮疹、发热、淋巴结肿大及内脏器官受累，在开始用药后2周~3个月内出现。由于皮肤和内脏症状多样，诊断该综合征具有挑战性。其发病涉及多种机制，包括与人类白细胞抗原（HLA）基因座相关的遗传易感性、导致反应性代谢产物形成及随后免疫反应的解毒缺陷、慢乙酰化以及人类疱疹病毒（包括EB病毒、人类疱疹病毒6型和7型）的再激活。DiHS/DRESS最常报道的病因是抗癫痫药、别嘌醇和磺胺类药物。我们报告1例由抗结核二线治疗药物丙硫异烟胺和对氨基水杨酸以及EB病毒再感染诱发的DiHS/DRESS病例。本病例所进行的斑贴试验尚未完全标准化，但它有助于评估和诊断DiHS/DRESS，且是一种安全的方法。
