血液中に一過性のHHV-6 DNAコピー数の上昇を確認しえた薬剤性過敏症症候群（DIHS）

・スルファメトキサゾール/トリメトプリル（ST）による典型的な薬剤性過敏症症候群（drug-induced hypersensitivity syndrome：DIHS）を経験した．

・一過性にヒトヘルペスウイルス 6（HHV-6），サイトメガロウイルス（CMV），EBウイルス（EBV）の再活性化を認めた．

・再活性化の証明にはReal-time PCR法によるウイルス定量が有用だった．

・プレドニゾロン（PSL）を増量し症状改善，その後順調に減量できた．

・DIHSの発症に関節リウマチ（RA）やメトトレキサート（MTX），ゴリムマブが関与した可能性がある．

（「症例のポイント」より）

　

Monitoring of the reactivation of herpes viruses in a patient with drug-induced hypersensitivity syndrome

　

Nakatsuka, Mari1）Yamamoto, Takenobu1, 2）Aoyama, Yumi1） 1）Department of Dermatology, Kawasaki Medical School 2）Department of Dermatology, Kawasaki Medical School General Medical Center

　

A 76-year-old man with rheumatoid arthritis treated with systemic corticosteroid at 10 mg/day, methotrexate at 10 mg/week and a single dose of 50 mg of golimumab presented with fever and diffuse erythema 49 days after starting trimethoprim-sulfamethoxazole. Laboratory data showed leukocytosis with 10％ atypical lymphocytes on admission. He was diagnosed with drug-induced hypersensitivity syndrome, and was treated with oral prednisolone at 40 mg/day. We observed reactivation of human herpes virus 6 (HHV-6), cytomegalovirus (CMV)and Epstein-Barr virus （EBV）by polymerase chain reaction, anti-viral immunoglobulin G, complement fixation test and antigenemia. HHV-6, CMV and EBV were sequentially reactivated during course of the case. Reactivation of HHV-6 detected 3 days prior to liver dysfunction suggested that the hepatitis developed as an anti-viral immune response.