Treatment of DIHS/DRESS syndrome with combined N-acetylcysteine, prednisone and valganciclovir - a hypothesis

Medical Science Monitor

Volumn 18, Issue 7, 2012, Pages

  Moling, Oswald ^a   Tappeiner, Lukas ^a   Piccin, Andrea ^a   Pagani, Elisabetta ^a   Rossi, Patrizia ^a   Rimenti, Giovanni ^a   Vedovelli, Claudio ^a   Mian, Peter ^a  

^a Ospedale Generale   (Italy)

Author keywords

Drug reaction with eosinophilia and systemic symptoms; Drug induced hypersensitivity syndrome; HHV 6; N acetylcysteine; Valganciclovir

Indexed keywords

ACETYLCYSTEINE; ALANINE AMINOTRANSFERASE; ALBUMIN; ASPARTATE AMINOTRANSFERASE; C REACTIVE PROTEIN; HEMOGLOBIN; IMMUNOGLOBULIN G; KETONE; LACTATE DEHYDROGENASE; LEVOTHYROXINE; PARACETAMOL; PREDNISONE; SALAZOSULFAPYRIDINE; VALGANCICLOVIR;

ABDOMINAL PAIN; ADULT; ALANINE AMINOTRANSFERASE BLOOD LEVEL; ANTIBODY TITER; ARTHRALGIA; ARTICLE; ASPARTATE AMINOTRANSFERASE BLOOD LEVEL; ASTHENIA; CASE REPORT; CD4 LYMPHOCYTE COUNT; CERVICAL LYMPHADENOPATHY; CORTICOSTEROID THERAPY; DRESS SYNDROME; EOSINOPHILIA; ERYTHEMA; FACE EDEMA; FEMALE; FEVER; HEMOGLOBIN BLOOD LEVEL; HUMAN; HUMAN HERPESVIRUS 6; HYPERTRANSAMINASEMIA; HYPOTENSION; INTERNATIONAL NORMALIZED RATIO; KETONURIA; LACTATE DEHYDROGENASE BLOOD LEVEL; LEUKOCYTE COUNT; LEUKOCYTOSIS; LIVER TOXICITY; LYMPHOCYTOSIS; MALAISE; MYALGIA; NEUTROPHIL COUNT; OXIDATIVE STRESS; PROTHROMBIN TIME; RASH; T LYMPHOCYTE; THORAX RADIOGRAPHY;

EID: 84863808095     PISSN: 12341010     EISSN: 16433750     Source Type: Journal    
DOI: 10.12659/MSM.883198     Document Type: Article

References (40)

1. Shiohara T, Inaoka M, Kano Y: Drug-induced hypersensitivity syndrome (DIHS): a reaction induced by a complex interplay among herpesviruses and antiviral and antidrug immune responses. Allergol Int, 2006; 55: 1-8
2. Eshki M, Allanore L, Musette P et al: Twelve-year analysis of severe cases of drug reaction with eosinophilia and systemic symptoms: a cause of unpredictable multiorgan failure. Arch Dermatol, 2009; 145: 67-72
3. Walsh SA, Creamer D: Drug reaction with eosinophilia and systemic symptoms (DRESS): a clinical update and review of current thinking. Clin Exp Dermatol, 2011; 36: 6-11
4. Aota N, Shiohara T: Viral connection between drug rashes and auto-immune diseases: how autoimmune responses are generated after resolution of drug rashes. Autoimmun Rev, 2009; 8: 488-94
5. Kardaun SH, Sidoroff A, Valeyrie-Allanore L et al: Variability in the clinical pattern of cutaneous side-effects of drugs with systemic symptoms: does a DRESS syndrome really exist? Br J Dermatol, 2007; 156: 609-11
6. Descamps V, Bouscarat F, Laglenne S et al: Human herpesvirus 6 infection associated with anticonvulsant hypersensitivity syndrome and reactive haemophagocytic syndrome. Br J Dermatol, 1997; 137: 605-8
7. Suzuki Y, Inagi R, Aono T et al: Human herpesvirus 6 infection as a risk factor for the development of severe drug-induced hypersensitivity syndrome. Arch Dermatol, 1998; 134: 1108-12
8. Tohyama M, Yahata Y, Yasukawa M et al: Severe hypersensitivity syndrome due to sulfasalazine associated with reactivation of human herpesvirus 6. Arch Dermatol, 1998; 134: 1113-17
9. Seishima M, Yamanaka S, Fujisawa T et al: Reactivation of human herpesvirus (HHV) family members other than HHV-6 in drug-induced hypersensitivity syndrome. Br J Dermatol, 2006; 155: 344-49
10. Kano Y, Hiraharas K, Sakuma K, Shiohara T: Several herpesviruses can reactivate in a severe drug-induced multiorgan reaction in the same sequential order as in graft-versus-host disease. Br J Dermatol, 2006; 155: 301-6
11. Tohyama M, Hashimoto K, Yasukawa M et al: Association of human herpesvirus 6 reactivation with the flaring and severity of drug-induced hypersensitivity syndrome. Br J Dermatol, 2007; 157: 934-40
12. Takahashi R, Kano Y, Yamazaki Y et al: Defective regulatory T cells in patients with severe drug eruptions: timing of the dysfunction is associated with the pathological phenotype and outcome. J Immunol, 2009; 182: 8071-79
13. Gabay C, De Bandt M, Palazzo E: Sulphasalazine-related life-threatening side effects: is N-acetylcysteine of therapeutic value? Clin Exp Rheumatol, 1993; 11: 417-20
14. Lau G, Kwan C, Chong SM: The 3-week sulphasalazine syndrome strikes again. Forensic Sci Int, 2001; 122: 79-84
15. Moling O, Cairon E, Rimenti G et al: Severe hepatotoxicity after therapeutic doses of acetaminophen. Clin Ther, 2006; 28: 755-60
16. Klotz U: Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid. Clin Pharmacokinet, 1985; 10: 285-302
17. Vyas PM, Roychowdhury S, Svensson CK: Role of human cyclooxygenase-2 in the bioactivation of dapsone and sulfamethoxazole. Drug Metab Dispos, 2006; 34: 16-18
18. Sanderson JP, Naisbitt DJ, Farrell J et al: Sulfamethoxazole and its metabolite nitroso sulfamethoxazole stimulate dendritic cell costimulatory signaling. J Immunol, 2007; 178: 5533-42
19. Lavergne SN, Wang H, Callan HE et al: "Danger" conditions increase sulfamethoxazole-protein adduct formation in human antigen-presenting cells. J Pharmacol Exp Ther, 2009; 331: 372-81
20. Sutmuller RP, Morgan ME, Netea MG et al: Toll-like receptors on regulatory T cells: expanding immune regulation. Trends Immunol, 2006; 27: 387-93
21. Kraaij MD, Savage ND, van der Kooij SW et al: Induction of regulatory T cells by macrophages is dependent on production of reactive oxygen species. Proc Natl Acad Sci USA, 2010; 107: 17686-91
22. Castrejon JL, Berry N, El-Ghaiesh S et al: Stimulation of human T cells with sulfonamides and sulfonamide metabolites. J Allergy Clin Immunol, 2010; 125: 411-18
23. Shiohara T, Kano Y: A complex interaction between drug allergy and viral infection. Clin Rev Allergy Immunol, 2007; 33: 124-33
24. Kano Y, Inaoka M, Shiohara T: Association between anticonvulsant hypersensitivity syndrome and human herpesvirus 6 reactivation and hypogammaglobulinemia. Arch Dermatol, 2004; 140: 183-88
25. Shiohara T, Kurata M, Mizukawa Y, Kano Y: Recognition of Immune Reconstitution Syndrome Necessary for Better Management of Patients with Severe Drug Eruptions and Those under Immunosuppressive Therapy. Allergol Int, 2010; 59: 333-43
26. De Bolle L, Naesens L, De Clercq E: Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev, 2005; 18: 217-45
27. Gonzalez FJ: The 2006 Bernard B. Brodie Award Lecture. Cyp2e1. Drug Metab Dispos, 2007; 35: 1-8
28. Kim SJ, Lee MY, Kwon do Y et al: Alteration in metabolism and toxicity of acetaminophen upon repeated administration in rats. J Pharmacol Sci, 2009; 111: 175-81
29. Lee WM, Hynan LS, Rossaro Let al: Acute Liver Failure Study Group. Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology, 2009; 137: 856-64
30. Mumtaz K, Azam Z, Hamid S et al: Role of N-acetylcysteine in adults with non-acetaminophen-induced acute liver failure in a center without the facility of liver transplantation. Hepatol Int, 2009; 3: 563-70
31. Kortsalioudaki C, Taylor RM, Cheeseman P et al: Safety and efficacy of N-acetylcysteine in children with non-acetaminophen-induced acute liver failure. Liver Transpl, 2008; 14: 25-30
32. Saito C, Zwingmann C, Jaeschke H: Novel mechanisms of protection against acetaminophen hepatotoxicity in mice by glutathione and N-acetylcysteine. Hepatology, 2010; 51: 246-54
33. Bémeur C, Vaquero J, Desjardins P, Butterworth RF: N-acetylcysteine attenuates cerebral complications of non-acetaminophen-induced acute liver failure in mice: antioxidant and anti-inflammatory mechanisms. Metab Brain Dis, 2010; 25: 241-49
34. Chen N, Aleksa K, Woodland C et al: N-Acetylcysteine prevents ifosfamide-induced nephrotoxicity in rats. Br J Pharmacol, 2008; 153: 1364-72
35. Bocquet H, Bagot M, Roujeau JC: Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS). Semin Cutan Med Surg, 1996; 15: 250-57
36. Rieder MJ, Uetrecht J, Shear NH, Spielberg SP: Synthesis and in vitro toxicity of hydroxylamine metabolites of sulfonamides. J Pharmacol Exp Ther, 1988; 244: 724-28
37. Rieder MJ, Krause R, Bird IA, Dekaban GA: Toxicity of sulfonamide-reactive metabolites in HIV-infected, HTLV-infected, and noninfected cells. J Acquir Immune Defic Syndr Hum Retrovirol, 1995; 8: 134-40
38. Gabay C, De Bandt M, Palazzo E: Sulphasalazine-related life-threatening side effects: is N-acetylcysteine of therapeutic value? Clin Exp Rheumatol, 1993; 11: 417-20
39. Lau G, Kwan C, Chong SM: The 3-week sulphasalazine syndrome strikes again. Forensic Sci Int, 2001; 122: 79-84
40. Cumbo-Nacheli G, Weinberger J, Alkhalil M et al: Anticonvulsant hypersensitivity syndrome: is there a role for immunomodulation? Epilepsia, 2008; 49: 2108-12