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Practical Dermatology Volume 41, Issue 3 （March 2019）

皮膚病診療 41巻3号（2019年3月発行）

特集 DIHS

臨床例

DIHS発症後皮膚にGVHD様反応が長期に続いた例三宅智子 ¹ , 木村摩耶 ¹ , 花山宜久 ³ , 青山裕美 ⁴ , 岩月啓氏 ² , 森実真 ¹ ¹岡山大学医学部皮膚科学 ²岡山大学 ³岡山大学病院総合内科 ⁴川崎医科大学皮膚科学キーワード： drug-induced hypersensitivity syndrome , graft versus-host disease like erythroderma , 免疫抑制薬 , EBV陽性びまん性大細胞型B細胞リンパ腫 Keyword: drug-induced hypersensitivity syndrome , graft versus-host disease like erythroderma , 免疫抑制薬 , EBV陽性びまん性大細胞型B細胞リンパ腫 pp.245-248

発行日 2019年3月1日 Published Date 2019/3/1

DOI https://doi.org/10.24733/pd.0000000879

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参考文献

・drug-induced hypersensitivity syndrome（DIHS）発症後，長期にgraft versushost disease like erythroderma（GVHD）様の皮膚症状が続いた．

・GVHD様の皮膚症状に対してプレドニゾロン（PSL）のみでは軽快しないため，他の免疫抑制薬を併用し皮膚症状は軽快した．

・免疫抑制薬使用中に脳内にEBV陽性びまん性大細胞型B細胞リンパ腫を生じた．

（「症例のポイント」より）

A case of graft versus-host disease like erythroderma after resolution of drug-induced hypersensitivity syndrome

Miyake, Tomoko1）Kimura, Maya1）Hanayama, Hisashi2）Aoyama, Yumi1, 3）Iwatsuki, Keiji1）Morizane, Shin1） 1）Department of Dermatology, Okayama University Hospital 2）Department of General Medical Medicine, Okayama University Hospital 3）Department of Dermatology, Kawasaki Medical School Hospital

A 75-year-old man developed Drug-Induced Hypersensitivity Syndrome (DIHS)in response to prednisolone treatment. His skin lesions waxed and waned for about four months, and the pathology of his skin lesions presented with the necrotic keratinocytes and interface dermatitis. Treatment with cyclosporine, tacrolimus or mycophenolate mofetil was initiated, and his skin lesions improved. However, at about 21 months of therapy, he presented with visual field defect and wandering, and revealed EBV-positive diffuse large B-cell lymphoma in his brain. He was treated successfully with radiation therapy. Four years after developing DIHS, he is alive with only fine scales at the skinlesion sites.