B型肝炎ウイルスの関与を考えたDIHS/DRESS疑い例

・播種状紅斑丘疹型の薬疹を認め，薬剤リンパ球刺激試験（drug-induced lymphocyte stimulation test：DLST）でスルピリドとクロチアゼパムが陽性となった．

・被疑薬にdrug-induced hypersensitivity syndrome（DIHS）の報告がある薬剤はなかったが，HHV-6の再活性化以外のDIHSの診断基準を認め,drug rash with eosinophilia and systemic symptoms（DRESS）の診断基準はすべて満たした．

・B型肝炎ウイルス（HBV）のキャリアであり,発症時のHBV-DNA量が高値であった．

・HBV-DNA量が陰性化後にDLST検査陽性の薬剤が再投与されたが，症状再燃を認めなかった．

（「症例のポイント」より）

　

A suspected case of drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms with high-titer serum hepatitis B virus DNA

　

Nakagawa, Yukinobu1）Tanaka, Mari1）Hayashi, Misa1）Kotobuki, Yorihisa1）Katayama, Ichiro1） 1）Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University

　

A 48-year-old man presented with a high fever, systemic maculopapular rash, conjunctival hyperemia and lymphadenopathy. His medical history included depression and chronic hepatitis B carrier status. A laboratory examination revealed hypereosinophilia, the existence of atypical lymphocytes, elevated serum TARC levels and a high titer of serum hepatitis B virus DNA. The drug-induced lymphocyte stimulation test was positive for sulpiride and clotiazepam. He did not meet the diagnostic criteria for drug-induced hypersensitivity syndrome, but drug rash with eosinophilia and systemic symptoms as HHV-6 reactivation was not observed. He was treated with oral prednisolone 40 mg a day, and his symptoms improved.