Case of lamotrigine‐induced drug adverse reaction under tocilizumab treatment with clinical and virological features of drug‐induced hypersensitivity syndrome

The pathological mechanisms and immunological kinetics of drug‐induced hypersensitivity syndrome (DIHS), including the relevance of interleukin (IL)‐6, remain unclear. We report a case of drug adverse reaction that does not fulfill the diagnostic criteria of DIHS but mimics its characteristic featur...

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Bibliographic Details
Published in:Journal of dermatology 2018-06, Vol.45 (6), p.738-741
Main Authors: Iriki, Hisato, Ouchi, Takeshi, Ito, Hiromi, Sawada, Miho, Mukai, Miho, Nomura, Hisashi, Baba, Yuko, Adachi, Takeya, Funakoshi, Takeru, Amagai, Masayuki, Takahashi, Hayato
Format: Article
Language:English
Subjects:
Adult
Antibodies, Monoclonal, Humanized - therapeutic use
Anticonvulsants - adverse effects
Arthritis, Rheumatoid - drug therapy
Biopsy
C-Reactive Protein - analysis
Case reports
DNA, Viral - isolation & purification
drug adverse reaction
Drug Hypersensitivity Syndrome - blood
Drug Hypersensitivity Syndrome - diagnosis
Drug Hypersensitivity Syndrome - drug therapy
Drug Hypersensitivity Syndrome - etiology
drug‐induced hypersensitivity syndrome
Epilepsy - drug therapy
Exanthema - chemically induced
Exanthema - diagnosis
Exanthema - drug therapy
Exanthema - pathology
Female
Fever
Fever - blood
Fever - chemically induced
Fever - diagnosis
Fever - drug therapy
Herpesviridae - genetics
Herpesviridae - isolation & purification
Humans
Hypersensitivity
Immunosuppressive agents
Interleukin-6 - antagonists & inhibitors
interleukin‐6
Lamotrigine
Liver diseases
Monoclonal antibodies
Prednisone - therapeutic use
Recurrence
Side effects
Skin
Skin - drug effects
Skin - pathology
tocilizumab
Triazines - adverse effects
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Description
Summary:The pathological mechanisms and immunological kinetics of drug‐induced hypersensitivity syndrome (DIHS), including the relevance of interleukin (IL)‐6, remain unclear. We report a case of drug adverse reaction that does not fulfill the diagnostic criteria of DIHS but mimics its characteristic features. Because the patient was under anti‐IL‐6 therapy at the onset, some symptoms typically seen in DIHS were absent, such as fever and leukocyte count abnormalities. However, the characteristic features of DIHS were clearly observed in the subsequent course, including the repeated recurrence of skin rash, prolonged liver dysfunction and reactivation of herpes viruses. This case suggested that IL‐6 role at the onset is not a main factor to determine the subsequent pathomechanism of DIHS and attention should be paid to the preceding therapy for achieving accurate diagnosis.
ISSN:0385-2407
1346-8138
DOI:10.1111/1346-8138.14288