Nakazato Saaya, Ogawa Shota, Oka Kohei, Sano Chiaki, Ohta Ryuichi
Family Medicine, Shimane University Faculty of Medicine, Izumo, JPN.
Community Care, Unnan City Hospital, Unnan, JPN.
Cureus. 2024 May 30;16(5):e61376. doi: 10.7759/cureus.61376. eCollection 2024 May.
A 50-year-old man presented with fever and a generalized rash, with chronic fatigue and lymphadenopathy for a year and a half. Initial tests ruled out lymphoproliferative disorders, showing reactive hyperplasia and cytomegalovirus. Symptoms worsened after ampicillin treatment, leading to suspected drug-induced hypersensitivity syndrome (DIHS). Upon admission, amoxicillin was discontinued, and prednisolone and antiviral treatment were initiated. The patient's condition improved with this therapy. A drug-induced lymphocyte stimulation test confirmed hypersensitivity to both ampicillin and allopurinol. This case illustrates the diagnostic challenge of chronic and acute DIHS because of the rare presentation. It underscores the need for high suspicion of DIHS in patients with chronic lymphadenopathy and fatigue, particularly with recent drug exposure. Effective management involves recognizing symptoms, withdrawing the offending drug, and using corticosteroids. Viral infections like cytomegalovirus can complicate DIHS diagnosis and treatment, necessitating a comprehensive approach. This case highlights the importance of considering DIHS in differential diagnoses and the complexities of managing it alongside co-infections in rural healthcare settings.
一名50岁男性出现发热和全身性皮疹，伴有慢性疲劳和淋巴结病已达一年半。初步检查排除了淋巴增殖性疾病，显示为反应性增生和巨细胞病毒感染。氨苄西林治疗后症状恶化，引发疑似药物性超敏反应综合征（DIHS）。入院后，停用阿莫西林，并开始使用泼尼松龙和抗病毒治疗。患者经此治疗病情好转。药物诱导的淋巴细胞刺激试验证实对氨苄西林和别嘌醇均过敏。该病例说明了慢性和急性DIHS诊断的挑战性，因其表现罕见。它强调了对于患有慢性淋巴结病和疲劳的患者，尤其是近期有药物暴露史的患者，高度怀疑DIHS的必要性。有效的管理包括识别症状、停用致病药物以及使用皮质类固醇。像巨细胞病毒这样的病毒感染会使DIHS的诊断和治疗复杂化，需要采取综合方法。该病例突出了在鉴别诊断中考虑DIHS的重要性，以及在农村医疗环境中与合并感染一起管理DIHS的复杂性。
