Volume 4 Supplement 3
Enhanced drug specific CD8+ T cell response at the presence of HHV-6 in DRESS patient: a case report
© Lee et al; licensee BioMed Central Ltd. 2014
Published: 18 July 2014
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening multiorgan systemic reaction that includes skin rash, fever, lymphadenopathy, internal organ involvement, and leukocytosis with eosinophilia. Evidence for reactivation of human herpes virus (HHV) 6 has been seen in some DRESS patients. We present a case of allopurinol-induced DRESS syndrome and describe the immune reactions through the identification of proliferation of CD8-positive T lymphocytes against HHV-6 peptides pool (HHV6-U90) by flow cytometry.
A 75-year-old man presented with a 10-day history of generalized rash accompanied by high fever, facial edema, hepatitis and azotemia. Prior to the appearance of the rash, the patient had been treated with allopurinol 200 mg/day due to gout for 20 days. Progressive rash, peripheral blood eosinophilia, multiple lymphadenopathy as well as a positive PCR test for HHV-6 were also present. The diagnosis of DRESS was made. The clinical symptoms and laboratory abnormalities were gradually recovered following administration of systemic corticosteroids (methylprednisolone 1 mg/kg).
Five years after the resolution of symptoms, lymphocyte transformation test was performed but significant lymphocyte proliferation was not observed with allopurinol stimulation itself in vitro. As a next step, CFSE T cell proliferation assays were conducted with the peripheral blood mononuclear cells of the allopurinol-induced DRESS patient and normal control. CD8+ cytotoxic proliferating T cells were not changed with stimulation of allopurinol in both DRESS patient and normal control. However, in DRESS patient, CD8+ cytotoxic proliferating T cell population was increased with stimulation of allopurinol and HHV6-U90 (33.9%¡æ41.2%).
This result suggests that T cell proliferation assay with stimulation of both drug and HHV-6 could be a helpful method to detect the causative agent.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.