経過中敗血症，急性腎不全，無顆粒球症，ディフィシル腸炎を合併し治療に難渋した薬剤性過敏症症候群

・経過中に認めた敗血症，急性腎不全，無顆粒球症，ディフィシル腸炎のうちdrug-induced hypersensitivity syndrome（DIHS）関連合併症は急性腎不全，無顆粒球症で，治療合併症は敗血症，ディフィシル腸炎と考えられた．

・DIHSの治療ではウイルスの再活性化に伴う合併症を想定しつつ，加えて感染合併症にも配慮するのが肝要である．

・DIHSを遷延させないための管理法は確立されていないため，ウイルス再活性化の診断やその程度の評価と，そのときどきの免疫状態の把握が症例ごとになされる必要がある．

（「症例のポイント」より）

　

Drug-induced hypersensitivity syndrome / drug reaction with eosinophilia and systemic symptoms with severe complications during the disease course

　

Takahashi, Kazuo1）Umemoto, Jyunichi2） 1）Department of Dermatology, International University of Health and Welfare Atami Hospital 2）Department of Dermatology, Yokosuka Kyosai Hospital

　

A 67-year-old man was diagnosed with drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms following carbamazepine therapy. During the disease course, he developed renal failure and agranulocytosis from reactivation of cytomegalovirus. In addition, he also developed sepsis due to S. aureus and colitis due to Clostridium difficile infection. The patient made a remarkable recovery and was discharged after being hospitalized for 3 months. While the specific cause of this prolonged illness is not presently clear, we consider that the initial treatment was delayed and inadequate.