Allergy Asthma Respir Dis.  2020 Jan;8(1):40-44. 10.4168/aard.2020.8.1.40.

A case of toxic epidermal necrolysis induced by cytomegalovirus infection followed by DRESS (drug reaction with eosinophilia and systemic symptoms)

• Sim DW
• Son S
• Yu J
• Koh YI

• KMID: 2469118
• DOI: http://doi.org/10.4168/aard.2020.8.1.40

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions. Although viral reactivation is associated with DRESS syndrome, its role in TEN remains unclear. An 80-year-old woman visited our hospital because of fever and skin eruption. DRESS syndrome was diagnosed and was thought to caused by the use of the drug allopurinol. She was treated by discontinuation of the drug and administration of systemic steroids. She recovered from DRESS syndrome and was discharged from the hospital with tapering doses of steroids prescribed. One week after discharge, she visited our hospital again as the skin rash recurred and oral pain as well as oral and ocular mucosal lesions developed. In addition to the skin rash, blisters and Nikolsky's sign that were different from the skin lesions present in the previous DRESS syndrome were observed. Unlike those in DRESS syndrome, the viral serological test results were positive for anti-cytomegalovirus (CMV) IgM and CMV polymerase chain reaction. Therefore, it was thought that TEN was due to reactivation of CMV and she was treated this with ganciclovir and intravenous immunoglobulin. Here, we report a case of TEN caused by viral reactivation after DRESS syndrome developed after use of allopurinol which recovered after steroid treatment.

Keyword

Cytomegalovirus; Drug hypersensitivity syndrome; Toxic epidermal necrolysis

MeSH Terms

Aged, 80 and over
Allopurinol
Blister
Cytomegalovirus Infections*
Cytomegalovirus*
Drug Hypersensitivity Syndrome
Eosinophilia*
Exanthema
Female
Fever
Ganciclovir
Humans
Immunoglobulin M
Immunoglobulins
Polymerase Chain Reaction
Serologic Tests
Skin
Steroids
Stevens-Johnson Syndrome*
Allopurinol
Ganciclovir
Immunoglobulin M
Immunoglobulins
Steroids

Figure

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  Fig. 1 Skin manifestation at first visit with fever and skin rash. (A) Maculopapular rash on trunk. (B, C) Undamaged lip and oral mucosa.

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  Fig. 2 Skin findings at revisit after discharge. (A) Skin rash and blister lesion of trunk. (B) Lip mucosal involvement. (C) Eye mucosal involvement. (D) Nikolsky's sign on trunk.

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