Association of anticonvulsant hypersensitivity syndrome with herpesvirus 6, 7
Association of anticonvulsant hypersensitivity syndrome with herpesvirus 6, 7
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DOI：
10.1016/j.eplepsyres.2006.02.006
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发表时间：
2006-07-01
影响因子：
2.2
通讯作者：
Erturk, Ozcan I. .
中科院分区：
文献类型：
--
作者：
Oskay, Tugba;Karademir, Asli;Erturk, Ozcan I. .
背景：抗惊厥药过敏综合征（AHS）是最严重的药疹形式之一，具有潜在致命性和多器官受累。最近，有人提出人类疱疹病毒（HHV）感染与该综合征有关，尽管该综合征的发病机制仍不清楚。方法：本研究的目的是确定AHS的临床特征以及病毒感染作为辅助因素的可能作用。我们前瞻性地分析了 23 例 AHS 病例的临床、实验室和病毒学结果。进行了包括病毒血清学和聚合酶链反应 (PCR) 在内的病毒研究。结果：最常见的抗惊厥药是卡马西平 (12)，其次是苯妥英 (6)、苯巴比妥 (4) 和加巴喷丁 (1)。所有患者均符合 AHS 的临床标准。尽管已观察到肝脏（52%）、肾脏（34%）和肺（13%）等内脏器官受累，但心脏、肺、甲状腺、肌肉、胰腺、脾脏和大脑受累的情况较少。我们还注意到两名患者因多器官衰竭而死亡。当前系列中未检测到与 HSV、VZV、HHV-8、CMV、EBV、麻疹、风疹和细小病毒 B 19 等病毒感染相关。 PCR 分析显示，血清抗 HHV-6 IgG 和 HHV-7 滴度增加，血清中存在 HHV-6 和 -7 DNA，表明 HHV-6 重新激活。与对照组相比，23 名患者中有 5 名患者的血清中检测到了 HHV-6 DNA，而两名患者中则检测到了 HHV-7。我们发现了 HHV-6 或 HHV-7 重新激活与仅卡马西平诱导的 AHS 发生有关的证据。结论：我们提出一些 AHS 病例不仅伴有 HHV-6 重新激活，还伴有 HHV-7 重新激活。 HHV 感染可能会导致 AHS 的严重程度、延长或复发，并且可能对一些接受抗惊厥药物的易感个体产生致命的后果。 (c) 2006 Elsevier B.V. 保留所有权利。
Background: Anticonvulsant hypersensitivity syndrome (AHS) is one of the most severe forms of drug eruption with potentially lethal, and multiorgan involvement. Recently, it has been suggested that Human Herpesvirus (HHV) infection has been involved in this syndrome, although the pathogenesis of this syndrome remains still unclear.Methods: The objective of this study was to determine the clinical characteristics of AHS and the possible role of viral infection as a co-factor. We prospectively analyzed clinical, laboratory and virological findings for 23 cases of AHS. A viral study including viral serology and a polymerase chain reaction (PCR) was performed.Results: The most common anticonvulsant was carbamazepine (12) followed by phenytoin (6), phenobarbital (4) and gabapentin (1). All patients met fulfill the clinical criteria of AHS. Even though internal organ involvement such as liver (52%), kidney (34%), and lung (13%) has been observed, involvement of heart, lung, thyroid, muscle, pancreas, spleen, and brain was less frequent. We also noted two patients who died due to multiorgan failure. No association with viral infection including HSV, VZV, HHV-8, CMV, EBV, measles, rubella and parvovirus B 19 was detected in the current series. Increased serum anti-HHV-6 IgG and HHV-7 titers and presence of HHV-6 and -7 DNA in serum, revealed by PCR analysis, suggested reactivation of HHV-6. In contrast to the control groups, DNA for HHV-6 was detected in serum in 5 out of the 23 patients while HHV-7 was seen in two patients. We found an evidence to link reactivation of HHV-6 or HHV-7 in the development of only carbamazepine-induced AHS.Conclusions: We propose that some cases of AHS are accompanied by reactivation of not only HHV-6 but also HHV-7. HHV infection may contribute to the severity, prolongation, or relapse of AHS and may possibly have fatal consequences in some susceptible individuals receiving the anticonvulsants. (c) 2006 Elsevier B.V. All rights reserved.