Visceral Involvements and Long-term Sequelae in Drug-induced Hypersensitivity Syndrome

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Diagnosis and clinical course of DIHS/DRESS

DIHS/DRESS appears after a 2-week to 3-month exposure to a limited number of drugs, including anticonvulsants, dapsone, allopurinol, and minocycline.10 The delayed onset in relation to the introduction of the causative drug is 1 of the more important features of DIHS/DRESS. This feature can be used to distinguish DIHS/DRESS from other types of drug eruptions, which typically begin 1 to 2 weeks after initiating therapy.

The criteria for the diagnosis of DRESS proposed by Bocquet and colleagues3

Visceral organ failures observed during the course of DIHS/DRESS

A variety of visceral involvements are observed at various time points after onset despite withdrawal of the causative drug. Box 1 lists visceral involvements that appear from the onset of the symptoms to clinical resolution of the disease. Some of them are strongly related to herpesvirus reactivation.

Long-term sequelae observed after symptom-free interval in DIHS

Several articles, including the authors', have shown the occurrence of autoimmune diseases and/or production of autoantibodies after resolution of DIHS/DRESS (Box 2). These autoimmune diseases include type 1 diabetes mellitus (DM),51, 52, 53, 54, 55, 56 autoimmune thyroid disease,38, 56 sclerodermoid GVHD-like lesions,57 and lupus erythematosus58, 59 (Fig. 4). Some of these autoimmune diseases are similar to those seen after bone marrow transplantation. According to the reports, autoimmune

Summary

DIHS/DRESS is a severe drug-induced systemic reaction with several herpesvirus reactivations. Multiple visceral organ failure such as hepatitis, nephritis, myocarditis, and pneumonitis can appear during the course of disease. The severity of DIHS/DRESS is most frequently determined by the presence of visceral involvement and mortality is related to the degree of systemic involvement. On the other hand, autoimmune diseases such as thyroid disease, sclerodermoid lesions, and lupus erythematosus

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    This work was supported by Health and Labor Sciences Research Grants from the Ministry of Health, Labor and Welfare of Japan (to Japanese Research Committee on Severe Cutaneous Adverse Reaction [J-SCAR]).

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