Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and Myocarditis: A Case Report and Literature Review on Fatal Complications of Reactivated Viral Infections
-
Amin Tajerian
,
Ali Pourvali
,
Masoud Movahedi
,
Maryam Mohammadi
,
Behzad Khansarinejad
,
Matin Pourmatin
,
Yazdan Ghandi
,
Mohammad Ali Daneshmand
Abstract
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a complex and potentially fatal hypersensitivity condition. We present a unique case report and literature review focusing on DRESS syndrome-associated myocarditis resulting from reactivated viral infections in a 21-year-old female.
3 weeks after 5-day oral co-trimoxazole consumption due to acne, she developed symptoms consistent with DRESS syndrome, including a generalized maculopapular rash. Despite prednisolone treatment, the patient developed fatal fulminant myocarditis linked to HHV-6 and CMV reactivation.
The patient's death highlights the importance of early recognition and careful management of DRESS syndrome, especially considering the potential viral reactivation that can lead to severe complications. Postmortem investigations revealed that viral reactivation caused myocarditis. Careful consideration must be given to corticosteroid usage in DRESS treatment, as inappropriate prescribing may promote viral reactivation and subsequent complications.
While high-dose corticosteroids initiated within the first week effectively suppress HHV-6 reactivation. Conversely, low-dose or late-start high-dose corticosteroids prove ineffective in preventing HHV-6 viremia. Late- onset or low- dose corticosteroids may lead to fatal complications following the primary viral reactivation.
1. Martínez-Cabriales SA, Rodríguez-Bolaños F, Shear NH. Drug Reaction with Eosinophilia and Systemic Symptoms (DReSS): How Far Have We Come? American Journal of Clinical Dermatology. 2019;20(2):217-36.
2. Cardones AR. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Clinics in Dermatology. 2020;38(6):702-11.
3. Kardaun SH, Sekula P, Valeyrie-Allanore L, Liss Y, Chu CY, Creamer D, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169(5):1071-80.
4. Cardones AR. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Clin Dermatol. 2020;38(6):702-11.
5. Kim DH, Koh YI. Comparison of diagnostic criteria and determination of prognostic factors for drug reaction with eosinophilia and systemic symptoms syndrome. Allergy Asthma Immunol Res. 2014;6(3):216-21.
6. Behera SK, Das S, Xavier AS, Selvarajan S. DRESS syndrome: a detailed insight. Hospital Practice. 2018;46(3):152-62.
7. Cho Y-T, Yang C-W, Chu C-Y. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System. International Journal of Molecular Sciences [Internet]. 2017; 18(6).
8. Kanannejad Z, Pourvali A, Esmaeilzadeh H, Shokouhi Shoormasti R, Reza Fazlollahi M, Fallahpour M, et al. Diagnosis and selection of alternative antibiotics in beta-lactams hypersensitivity reactions: Current recommendations and challenges. International Immunopharmacology. 2023;122:110573.
9. Hashizume H, Fujiyama T, Tokura Y. Reciprocal contribution of Th17 and regulatory T cells in severe drug allergy. J Dermatol Sci. 2016;81(2):131-4.
10. Miyagawa F, Asada H. Current Perspective Regarding the Immunopathogenesis of Drug-Induced Hypersensitivity Syndrome/Drug Reaction with Eosinophilia and Systemic Symptoms (DIHS/DRESS). International Journal of Molecular Sciences. 2021;22(4):2147.
11. Choudhary S, McLeod M, Torchia D, Romanelli P. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. J Clin Aesthet Dermatol. 2013;6(6):31-7.
12. Kim GY, Anderson KR, Davis DMR, Hand JL, Tollefson MM. Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature. J Am Acad Dermatol. 2020;83(5):1323-30.
13. Moling O, Tappeiner L, Piccin A, Pagani E, Rossi P, Rimenti G, et al. Treatment of DIHS/DRESS syndrome with combined N-acetylcysteine, prednisone and valganciclovir--a hypothesis. Med Sci Monit. 2012;18(7):Cs57-62.
14. Ishida T, Kano Y, Mizukawa Y, Shiohara T. The dynamics of herpesvirus reactivations during and after severe drug eruptions: their relation to the clinical phenotype and therapeutic outcome. Allergy. 2014;69(6):798-805.
15. Tohyama M, Hashimoto K, Oda F, Namba C, Sayama K. Influence of corticosteroid therapy on viral reactivation in drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. The Journal of Dermatology. 2020;47(5):476-82.
16. Morimoto T, Sato T, Matsuoka A, Sakamoto T, Ohta K, Ando T, et al. Trimethoprim-sulfamethoxazole-induced hypersensitivity syndrome associated with reactivation of human herpesvirus-6. Intern Med. 2006;45(2):101-5.
17. Tohyama M, Hashimoto K, Yasukawa M, Kimura H, Horikawa T, Nakajima K, et al. Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome. Br J Dermatol. 2007;157(5):934-40.
18. Miyashita K, Shobatake C, Miyagawa F, Kobayashi N, Onmori R, Yonekawa S, et al. Involvement of Human Herpesvirus 6 Infection in Renal Dysfunction Associated with DIHS/DRESS. Acta Derm Venereol. 2016;96(1):114-5.
19. Li JC. Reactivation of Human Herpesvirus (HHV) 6 as Etiology of Acute Liver Injury in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Case Report. Cureus. 2022;14(9):e29697.
20. Bourgeois GP, Cafardi JA, Groysman V, Hughey LC. A review of DRESS-associated myocarditis. J Am Acad Dermatol. 2012;66(6):e229-36.
21. Radovanovic M, Jevtic D, Calvin AD, Petrovic M, Paulson M, Rueda Prada L, et al. “Heart in DRESS”: cardiac manifestations, treatment and outcome of patients with drug reaction with eosinophilia and systemic symptoms syndrome: a systematic review. Journal of Clinical Medicine. 2022;11(3):704.
22. Leone O, Pieroni M, Rapezzi C, Olivotto I. The spectrum of myocarditis: from pathology to the clinics. Virchows Archiv. 2019;475(3):279-301.
23. Yamada A, Takeichi T, Kiryu K, Takashino S, Yoshida M, Kitamura O. Fatal human herpes virus 6B myocarditis: Postmortem diagnosis of HHV-6B based on CD134+ T-cell tropism. Legal Medicine. 2022;54:102007.
24. Roubille C, Brunel AS, Gahide G, Vernhet Kovacsik H, Le Quellec A. Cytomegalovirus (CMV) and acute myocarditis in an immunocompetent patient. Intern Med. 2010;49(2):131-3.
25. Reddy S, Eliassen E, Krueger GR, Das BB. Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children. Ann Pediatr Cardiol. 2017;10(3):259-68.
26. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48, 48a-48d.
27. Scherger S, Mathur S, Bajrovic V, Johnson SC, Benamu E, Ramanan P, et al. Cytomegalovirus myocarditis in solid organ transplant recipients: A case series and review of literature. Transpl Infect Dis. 2020;22(3):e13282.
2. Cardones AR. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Clinics in Dermatology. 2020;38(6):702-11.
3. Kardaun SH, Sekula P, Valeyrie-Allanore L, Liss Y, Chu CY, Creamer D, et al. Drug reaction with eosinophilia and systemic symptoms (DRESS): an original multisystem adverse drug reaction. Results from the prospective RegiSCAR study. Br J Dermatol. 2013;169(5):1071-80.
4. Cardones AR. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Clin Dermatol. 2020;38(6):702-11.
5. Kim DH, Koh YI. Comparison of diagnostic criteria and determination of prognostic factors for drug reaction with eosinophilia and systemic symptoms syndrome. Allergy Asthma Immunol Res. 2014;6(3):216-21.
6. Behera SK, Das S, Xavier AS, Selvarajan S. DRESS syndrome: a detailed insight. Hospital Practice. 2018;46(3):152-62.
7. Cho Y-T, Yang C-W, Chu C-Y. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System. International Journal of Molecular Sciences [Internet]. 2017; 18(6).
8. Kanannejad Z, Pourvali A, Esmaeilzadeh H, Shokouhi Shoormasti R, Reza Fazlollahi M, Fallahpour M, et al. Diagnosis and selection of alternative antibiotics in beta-lactams hypersensitivity reactions: Current recommendations and challenges. International Immunopharmacology. 2023;122:110573.
9. Hashizume H, Fujiyama T, Tokura Y. Reciprocal contribution of Th17 and regulatory T cells in severe drug allergy. J Dermatol Sci. 2016;81(2):131-4.
10. Miyagawa F, Asada H. Current Perspective Regarding the Immunopathogenesis of Drug-Induced Hypersensitivity Syndrome/Drug Reaction with Eosinophilia and Systemic Symptoms (DIHS/DRESS). International Journal of Molecular Sciences. 2021;22(4):2147.
11. Choudhary S, McLeod M, Torchia D, Romanelli P. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome. J Clin Aesthet Dermatol. 2013;6(6):31-7.
12. Kim GY, Anderson KR, Davis DMR, Hand JL, Tollefson MM. Drug reaction with eosinophilia and systemic symptoms (DRESS) in the pediatric population: A systematic review of the literature. J Am Acad Dermatol. 2020;83(5):1323-30.
13. Moling O, Tappeiner L, Piccin A, Pagani E, Rossi P, Rimenti G, et al. Treatment of DIHS/DRESS syndrome with combined N-acetylcysteine, prednisone and valganciclovir--a hypothesis. Med Sci Monit. 2012;18(7):Cs57-62.
14. Ishida T, Kano Y, Mizukawa Y, Shiohara T. The dynamics of herpesvirus reactivations during and after severe drug eruptions: their relation to the clinical phenotype and therapeutic outcome. Allergy. 2014;69(6):798-805.
15. Tohyama M, Hashimoto K, Oda F, Namba C, Sayama K. Influence of corticosteroid therapy on viral reactivation in drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. The Journal of Dermatology. 2020;47(5):476-82.
16. Morimoto T, Sato T, Matsuoka A, Sakamoto T, Ohta K, Ando T, et al. Trimethoprim-sulfamethoxazole-induced hypersensitivity syndrome associated with reactivation of human herpesvirus-6. Intern Med. 2006;45(2):101-5.
17. Tohyama M, Hashimoto K, Yasukawa M, Kimura H, Horikawa T, Nakajima K, et al. Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome. Br J Dermatol. 2007;157(5):934-40.
18. Miyashita K, Shobatake C, Miyagawa F, Kobayashi N, Onmori R, Yonekawa S, et al. Involvement of Human Herpesvirus 6 Infection in Renal Dysfunction Associated with DIHS/DRESS. Acta Derm Venereol. 2016;96(1):114-5.
19. Li JC. Reactivation of Human Herpesvirus (HHV) 6 as Etiology of Acute Liver Injury in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS) Syndrome: A Case Report. Cureus. 2022;14(9):e29697.
20. Bourgeois GP, Cafardi JA, Groysman V, Hughey LC. A review of DRESS-associated myocarditis. J Am Acad Dermatol. 2012;66(6):e229-36.
21. Radovanovic M, Jevtic D, Calvin AD, Petrovic M, Paulson M, Rueda Prada L, et al. “Heart in DRESS”: cardiac manifestations, treatment and outcome of patients with drug reaction with eosinophilia and systemic symptoms syndrome: a systematic review. Journal of Clinical Medicine. 2022;11(3):704.
22. Leone O, Pieroni M, Rapezzi C, Olivotto I. The spectrum of myocarditis: from pathology to the clinics. Virchows Archiv. 2019;475(3):279-301.
23. Yamada A, Takeichi T, Kiryu K, Takashino S, Yoshida M, Kitamura O. Fatal human herpes virus 6B myocarditis: Postmortem diagnosis of HHV-6B based on CD134+ T-cell tropism. Legal Medicine. 2022;54:102007.
24. Roubille C, Brunel AS, Gahide G, Vernhet Kovacsik H, Le Quellec A. Cytomegalovirus (CMV) and acute myocarditis in an immunocompetent patient. Intern Med. 2010;49(2):131-3.
25. Reddy S, Eliassen E, Krueger GR, Das BB. Human herpesvirus 6-induced inflammatory cardiomyopathy in immunocompetent children. Ann Pediatr Cardiol. 2017;10(3):259-68.
26. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, Felix SB, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34(33):2636-48, 48a-48d.
27. Scherger S, Mathur S, Bajrovic V, Johnson SC, Benamu E, Ramanan P, et al. Cytomegalovirus myocarditis in solid organ transplant recipients: A case series and review of literature. Transpl Infect Dis. 2020;22(3):e13282.
| Files | ||
| Issue | Vol 23 No 3 (2024) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/ijaai.v23i3.15643 | |
| Keywords | ||
| Cytomegalovirus Drug hypersensitivity syndrome Herpesvirus 6, human Myocarditis Sulfamethoxazole drug combination Trimethoprim Virus latency | ||
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How to Cite
1.
Tajerian A, Pourvali A, Movahedi M, Mohammadi M, Khansarinejad B, Pourmatin M, Ghandi Y, Daneshmand MA. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome and Myocarditis: A Case Report and Literature Review on Fatal Complications of Reactivated Viral Infections. Iran J Allergy Asthma Immunol. 2024;23(3):339-346.
