心筋炎を合併したメキシレチンによる薬剤性過敏症症候群

・心筋炎を合併したメキシレチンによる薬剤性過敏症症候群（drug induced hypersensitivity syndrome：DIHS）を経験した．

・human herpes virus 6（HHV-6）の再活性化を認めたが，その他のヘルペス属ウイルス の再活性化は確認できなかった．

・ステロイド全身投与で治療を行ったが，小腸内出血を併発し，第72病日に死亡した．

（「症例のポイント」より）

　

A case of drug-induced hypersensitivity syndrome due to mexiletine associated with myocarditis

　

Yusa, Shino1）Kikuchi, Katsuko1）Takita, Akiko1）Tojo, Genichi2）Aiba, Setsuya1） 1）Department of Dermatology, Tohoku University Graduate School of Medicine 2）Department of Dermatology ,South Miyagi Medical Center

　

A 54-year-old man developed multiple erythematous lesions on the whole body with edema of the face, lymphadenopathy and fever approximately two weeks after the start of mexiletin administration. From the clinical symptoms, laboratory findings, and histopathological findings from skin biopsy, the diagnosis of drug-induced hypersensitivity syndrome (DIHS) was made. He was treated with systemic steroid (predonisolone 50 mg/day). After 10 days of hospitalization, his blood pressure suddenly decreased with an increase of myocardial escape enzymes by laboratory examination. Myocardial biopsy revealed myocarditis. Despite therapy with systemic steroid and paracorporeal ventricular assist device, he died from intestinal bleeding 72 days after hospitalization. During the course, a rise in titers of anti-human herpesvirus-6 antibody (IgG) and anti-CMV antibody was detected. Though DIHS associated with myocarditis is rare, the prognosis is poor and the onset mechanism is still unknown.