TENとの鑑別を要したDIHS

・TEN（toxic epidermal necrolysis）と鑑別を要したdrug-induced hypersensitivity syndrome（DIHS）の1例を経験した．

・カルバマゼピン内服1カ月半後の発症でありDIHSが疑われる一方，初診時に水疱を形成しており，TENとの鑑別を要した．

・治療はステロイドパルス療法が奏効した．

（「症例のポイント」より）

　

A case of drug-induced hypersensitivity syndrome which was difficult to differentiate from toxic epidermal necrosis

　

Aoyama, Kazuhiro1）Negishi, Mayuko1）Togawa, Yaei1）Matsue, Hiroyuki1） 1）Department of Dermatology, Chiba University Graduate School of Medicine

　

A 63-year-old female referred to our hospital because of whole body erythema and multiple tense blister accompanied by fever after starting administration of carbamazepine for trigeminal neuralgia from a month ago. The Nikolsky phenomenon could not be elicited unlike toxic epidermal necrosis. She had swelling of the cervical lymph node but no mucosal rash. Blood tests showed liver dysfunction, increased lymphocytes and eosinophils counts. The index of serum HHV-6 IgG level increased 4-fold after 14 weeks compared with base line. Pathological findings showed no necrosis in the epidermis, meanwhile edema in the dermal papilla layer was observed at the blistering area. We diagnosed it as a typical DIHS. Steroid pulse therapy was effective, and her symptoms improved.