Skip to main content

Enhanced drug specific CD8+ T cell response at the presence of HHV-6 in DRESS patient: a case report

Background

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.

Case history

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).

Result

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%).

Conclusion

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Hye-Ryun Kang.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, H.S., Lim, KH., Lee, J.W. et al. Enhanced drug specific CD8+ T cell response at the presence of HHV-6 in DRESS patient: a case report. Clin Transl Allergy 4, P86 (2014). https://doi.org/10.1186/2045-7022-4-S3-P86

Download citation

Keywords

  • Gout
  • Eosinophilia
  • Allopurinol
  • Cell Proliferation Assay
  • Human Herpes Virus