Accordingly, the reactivation of HHV-6 did not result from coinfection with these viruses. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 1998;134(9):1113–1117. • In patients with intestinal and urinary obstructions. We suggest that HHV-6 infection may be a required cause of hypersensitivity syndrome.  TTakahashi This site needs JavaScript to work properly.  DAJosephs We believe these cases represent hypersensitivity syndrome due to sulfasalazine therapy. However, we determined that her anti–HHV-6 IgG titer had increased from 1:320 on the second hospital day to 1:2560 on the sixth hospital day when a preserved serum sample was examined. Patients with porphyria. Sulfasalazine therapy was discontinued 4 days later.  KKAsh to download free article PDFs, Yamakado S, Yoshida Y, Yamada T, Kishida T, Kobayashi M, Nomura T. Intern Med. Clinical signs included a maculopapular rash progressing to exfoliative erythroderma, fever, and lymphadenopathy. Common side effects of Azulfidine include gastrointestinal disturbances, headache, allergic reactions, rash when exposed to sunlight, and changes in skin or urine color.  PM Circulating cytokine levels in patients with rheumatoid arthritis: results of a double blind trial with sulphasalazine. Sulfasalazine is broken down to sulfapyridine (a sulfonamide) and 5-aminosalicylic acid (mesalamine). No serologic evidence of viral infections has been reported with this syndrome; however, human herpesvirus 6 infection has not been specifically investigated, which could cause an infectious mononucleosislike syndrome. 1992 Jan;31(1):108-13. doi: 10.2169/internalmedicine.31.108. Some patients may have a similar reaction to Asacol HD tablets or to other compounds that  KOkuno Two cases of hypersensitivity syndrome due to sulfasalazine use were associated with the reactivation of human herpesvirus 6, which may be a required cause of hypersensitivity syndrome.  DE Detection of human herpesvirus-6 DNA in peripheral blood and saliva.  AAGoldenberg A marked increase in anti–HHV-6 IgG titers strongly indicates a primary or reactivated infection of HHV-6. DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) is a drug-induced hypersensitivity syndrome that can mimic malignant lymphoma. We report 2 cases of hypersensitivity syndrome induced by the use of sulfasalazine. Levy From the Department of Dermatology (Drs Tohyama, Yahata, and Hashimoto) and the First Department of Internal Medicine (Dr Yasukawa), Ehime University School of Medicine, Ehime, the Department of Microbiology, Osaka University Medical School, Osaka (Drs Inagi and Yamanishi), and the Department of Dermatology, Tokushima University School of Medicine, Tokushima (Dr Urano), Japan. However, these proposed pathomechanisms do not fully explain the phenomenon of hypersensitivity syndrome, which is induced by only a select group of medications. Seroconversion to human herpesvirus 6 following liver transplantation is a marker of cytomegalovirus disease. Human herpesvirus 6 has been identified as the cause of exanthem subitum.14 Most people are infected with HHV-6 in early childhood. Treatment with all medications except ketotifen fumarate was discontinued. Sumiyoshi Genotyping of HHV-6 was performed as described previously.10 Human herpesvirus 6 DNA was amplified using a triple primer mix of 5′-CAGAAGTG-CCAGGGAAATCC-3′, 5′-TTATCGGGGCTGTAAGCCAA-3′, and 5′-TTTGCT-TCCCGGAGTCATAGA-3′. David A skin biopsy specimen obtained from the upper portion of the patient's right arm showed lymphocytic infiltration in the epidermis with necrotic keratinocytes, partial liquefaction degeneration of basal cells, and perivascular lymphocytic infiltration in the dermis (Figure 2). Secchiero Results from a physical examination revealed tender generalized lymphadenopathy.  KEizuru A Case of Sulfasalazine-Induced Hypersensitivity Syndrome Confirmed by Enzyme-Linked Immunospot Assay Parkpoom Phatharacharukul, 1 and Jettanong Klaewsongkram 2 1 Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Salahuddin Nevertheless, the patient's skin eruption and general condition showed little improvement, so she was admitted to Tokushima University Hospital, Tokushima, Japan. The PCR product from HHV-6 variant A was 488 bp, and the product from variant B was 259 bp.  ECKatsafanas Sulfa drugs (also called sulphur drugs or sulfonamide-containing drugs) is an imprecise term that generally refers to drugs that contain a sulfonamide functional group in their chemical structure. Phenobarbital has been reported to cause hypersensitivity syndrome13; therefore, the patient could have developed hypersensitivity syndrome with reactivated HHV-6 from treatment with phenobarbital. Sulfasalazine has been reported to modulate the immune response by inhibiting the secretion of IgA and the production of interleukin 1 and tumor necrosis factor α.29,30 These effects of sulfasalazine on the immune system may facilitate the reactivation of HHV-6 by activated T cells and induce the constellation of symptoms and signs of hypersensitivity syndrome.  DALaurent A severe adverse reaction to sulfasalazine therapy has been associated with hypersensitivity syndrome, the clinical features of which are similar to infectious mononucleosis.  RFClark Peripheral blood mononuclear cells (PBMCs) were separated and cultured with umbilical cord blood mononuclear cells as described previously.8 The cytopathic effect of HHV-6 was examined with an inverted microscope. Severe, lifethreatening, systemic hypersensitivity reactions such as drug rash with - eosinophilia and systemic symptoms (DRESS) have been reported in patients taking various drugs including sulfasalazine.  RMBroods 1998;134:1113-1117 ULFASALAZINE IS a common therapeuticdrugusedtotreat inflammatory bowel dis-ease, rheumatoid arthritis, The patients showed similar clinical courses associated with reactivated HHV-6 infection.  Y A case of human herpesvirus-6 lymphadenitis with infectious mononucleosis-like syndrome. © BMJ Publishing Group Limited 2020.  DVMarkham Treatment with 0.5 g/d of sulfasalazine was started after all medications except loxoprofen had been discontinued.  PD Here, we report the first case, to our knowledge, of a patient with previously unidentified SIHS who developed a significantly more rapid and extreme recurrence on re-exposure to sulfasalazine. It should be noted that the patients' clinical conditions improved with the use of systemic corticosteroids. Methods: PBMC from 2 patients with severe hypersensitivity syndrome to sulfasalazine, 3 patients with sulfamethoxazole allergy and 5 healthy donors were isolated and incubated with medium only (negative control), 2 concentrations (10, 100 μg/ml) of sulfapyridine, 2 concentrations (100, 200 μg/ml) of sulfamethoxazole, and tetanus toxoid (10 μg/ml) as a positive control. Human herpesvirus 6 infection in renal transplantation. A severe adverse reaction to sulfasalazine has been identified as a type of hypersensitivity syndrome.1-4 The reaction, including fever, skin rash, lymphadenopathy, and internal organ involvement, usually occurs 2 to 5 weeks after initiating treatment with sulfasalazine.  BKKalow  KShiraki  VRoujeau  et al.  KG Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity. Autoimmune disorders may also develop as a sequela of the condition. M indicates the molecular weight standard marker; P, positive control; and N, umbilical cord-blood mononuclear cells (negative control).  BJFox In addition, the increase in the anti–HHV-6 IgG titers was observed more than 2 weeks after the onset of disease. 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Yoshikawa Epub 2013 Apr 4. Conclusions  Yalcin Sulfasalazine has been reported to induce pulmonary eosinophilia and hypersensitivity with symptoms of dyspnea and fever. Carrigan A 22-year-old Japanese woman who presented with abdominal pain and bloody diarrhea was diagnosed as having ulcerative colitis.  LIRudzki  MAKnox  MH Azulfidine-(sulfasalazine-) induced hepatic injury. Autoimmune disorders may also develop as a sequela of the condition.  et al.  MJNash These data indicated the reactivation of HHV-6 in the patient. Privacy Policy|  RPSchloemann It is characterised by a high fever (>38°C), a cutaneous eruption, lymphadenopathy, and single or multiorgan involvement. A 58-year-old woman with rheumatoid arthritis (RA) developed fever, skin eruptions, leukocytopenia, and thrombocytopenia, 3 weeks after treatment with  JAFerro pms-SULFASALAZINE and pms-SULFASALAZINE-E. C. (sulfasalazine) are contraindicated: • In patients with hypersensitivity to sulfasalazine, its metabolites, or any other component of the product (See Composition), sulfonamides, or salicylates. In this report, a case of sulfasalazine- induced DRESS syndrome (the acronym for Drug Rash with Eosinophilia and Systemic Symptoms) is described.  JE Sulfapyridine-induced serum-sickness-like syndrome associated with plasmacytosis, lymphocytosis and multiclonal gamma-globulinopathy.  TSuga This case illustrates that the hemophagocytic syndrome associated with reactivation of EBV can occur as part of drug hypersensitivity reactions in RA patients taking sulfasalazine.  TChawla 5.3 Hypersensitivity Reactions . Medium-to-long-term follow-up is required even after complete resolution of the condition. Hypersensitivity syndrome due to the use of sulfonamides and anticonvulsants may be related to individual genetic polymorphisms in the enzymes involved in the metabolism cascade of these drugs.25,26 It is hypothesized that the reactive metabolite binds to tissue macromolecules and causes cell damage or acts as a hapten and elicits an immune response. Human herpesvirus-6 infection in bone marrow transplantation.  E Frequent isolation of HHV-6 from saliva and high seroprevalence of the virus in the population. 2014 Mar;73(2):180-3. doi: 10.1007/s00393-013-1308-5.  SP Anticonvulsant hypersensitivity syndrome.  |  Z Rheumatol. Callot Our website uses cookies to enhance your experience.  RSHoness  SKTapper • In infants under 2 years of age. Terms of Use| Betamethasone therapy was discontinued while treatment with sulfasalazine was increased to 2 g/d. Leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance were also observed. On the sixth hospital day, results from laboratory studies revealed the following values: aspartate aminotransferase, 755 U/L; alanine aminotransferase, 1058 U/L; lactate dehydrogenase, 1712 U/L; and total bilirubin, 41.04 µmol/L (2.4 mg/dL). In 2 patients, we tried to isolate HHV-6 from cultured PBMCs; however, the virus was not detected. HHS Antibody titers against HHV-7, Epstein-Barr virus, cytomegalovirus, rubella, adenovirus, and toxoplasma did not change throughout the clinical course. Currently, this drug is approved by the US Food and Drug Administration (FDA) for the treatment of ulcerative colitis and rheumatoid arthritis. MacDermott  K This is a delayed type IVb hypersensitivity syndrome that presents skin eruptions, fever, lymphadenopathy, hepatitis and hematological abnormalities like eosinophilia and atypical lymphocytes.  GMRathjen NIH The lavage specimen showed a … Keywords: The evaluation of HHV-6 antibody titers is controversial. Seven days after the onset of the disease, sulfasalazine therapy was discontinued, and the patient was treated with 50 mg/d of oral prednisolone for 4 days. Sulfasalazine Sulfasalazine 2013-01-18 00:00:00 Reactions 723 - 17 Oct 1998 Hypersensitivity syndrome associated with reactivation of human herpesvirus 6: 2 case reports Sulfasalazine-induced hypersensitivity syndrome was associated with the reactivation of human herpesvirus 6 (HHV-6) in 2 patients. Two cases of hypersensitivity syndrome due to sulfasalazine use were associated with the reactivation of human herpesvirus 6, which may be a required cause of hypersensitivity syndrome. OBSERVATIONS: We report 2 cases of hypersensitivity syndrome induced by the use of sulfasalazine. We report 2 cases of hypersensitivity syndrome induced by the use of sulfasalazine.  KTakeshita Han Accessibility Statement. Severe infectious mononucleosis-like syndrome and primary human herpesvirus 6 infection in an adult.  VAFranic  K  TKazuhiro  PCarrigan The clinical features of the syndrome appeared 18 and 32 days after administration of sulfasalazine.  THigashi IgG antibody to HHV-6 was determined using the indirect immunofluorescent antibody assay described previously.11 Mononuclear cells infected with HHV-6 (HST strain) were used as a target antigen. Sulfasalazine-induced hypersensitivity syndrome (SIHS) is a serious systemic delayed adverse drug reaction that is associated with significant morbidity and mortality. Sulfasalazine-induced hypersensitivity syndrome (SIHS) is a serious systemic delayed adverse drug reaction that is associated with significant morbidity and mortality. Oral sulfasalazine inhibits the absorption and metabolism of folic acid and may cause folic acid deficiency, potentially resulting in serious blood disorders (e.g. Salazopyrin EN tablets are also used to treat rheumatoid arthritis, which is a painful joint disease. Clipboard, Search History, and several other advanced features are temporarily unavailable. DRESS Syndrome: Drug Rash with Eosinophilia and Systemic Symptoms.  SKTapper We report 2 cases of sulfasalazine-induced severe hypersensitivity syndrome associated with the reactivation of HHV-6.  DRAsano Recently, a severe infectious mononucleosislike syndrome caused by HHV-6 infection was reported in immunocompetent adults.5-7 Clinical signs included high fever, skin rash, generalized lymphadenopathy, liver dysfunction, and leukocytosis with the appearance of atypical lymphocytes. Abnormal laboratory findings included a white blood cell count of 23.6 × 109/L (20% atypical lymphocytes and 11% eosinophils). Although the 3 reported cases were described as primary HHV-6 infection, the possibility of reactivated HHV-6 could not be excluded because of an absent or low anti–HHV-6 IgM response.24 If the infectious mononucleosislike syndrome was precipitated by reactivated HHV-6 infection, possible causes of the reactivation were not delineated. The DNA was detected from frozen skin specimens obtained on the patient's 19th hospital day, but not from paraffin-embedded skin specimens obtained on the 6th day.  RSTedesco The presence of atypical lymphocytes and mononucleosislike symptoms led us to examine the possibility of viral infections.  NHSpielberg A generalized maculopapular rash was observed over the patient's face, trunk, and extremities (Figure 1). Sulfasalazine-induced hypersensitivity syndrome (SIHS) is a serious systemic delayed adverse drug reaction that is associated with significant morbidity and mortality.  HDPrada Therefore, sulfasalazine is contraindicated in patients with sulfasalazine hypersensitivity, salicylate hypersensitivity, sulfonamide hypersensitivity, and 5-aminosalicylates hypersensitivity. Salazopyrin is used to treat and manage ulcerative colitis and Crohn's disease which are inflammatory bowel diseases. drugs and medicines; immunology; intensive care. Mauri-Hellweg Okuno We did not observe an increase in their anti–HHV-6 IgG titers throughout their clinical courses.  et al. Yakushijin Edema of the face was also present. Here, we report the first case, to our knowledge, of a patient with previously unidentified SIHS who developed a significantly more rapid and extreme recurrence on re-exposure to sulfasalazine. Fulminant hepatitis in primary human herpesvirus-6 infection. These drugs have a variety of uses and can be classified into antibiotics and non-antibiotic drugs. The clinical features of the syndrome appeared 18 and 32 days after administration of sulfasalazine. Therefore, the adverse drug reaction causing hypersensitivity syndrome requires additional factors. Facial edema was also present.  MACarrigan An analysis of peripheral blood lymphocyte surface markers showed 35% CD4+ T cells and 30% CD8+ T cells.  et al. DRESS typically develops three weeks to three months after starting treatment with the precipitating drug.  DBrander Sulfonamide antimicrobials are commonly reported as causing drug allergy and have been implicated in a variety of hypersensitivity reactions including immediate IgE-mediated reactions, benign T-cell-mediated rashes, and severe cutaneous adverse reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. In conclusion, we demonstrate that a drug-induced hypersensitivity syndrome due to sulfasalazine use is associated with reactivation of HHV-6 and an infectious mononucleosislike illness.  W Differences in metabolism of sulfonamides predisposing to idiosyncratic toxicity. Gopal Tohyama M, Yahata Y, Yasukawa M, et al.  Y Hypersensitivity reactions have been reported in patients taking sulfasalazine. Customize your JAMA Network experience by selecting one or more topics from the list below. The clinical features of the syndrome appeared 18 and 32 days after administration of sulfasalazine. To confirm this observation, it must be further investigated in other patients.  NHSpielberg Clinical signs included a maculopapular rash progressing to exfoliate erythroderma, fever, and lymphadenopathy. Sulfasalazine should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.  et al.  JCBagot Findings from a microscopic examination of a skin lesion on the upper portion of the right arm of patient 1 shows infiltration of lymphocytic cells in the epidermis with necrotic keratinocytes, partial liquefaction degeneration of basal cells, and perivascular infiltration of lymphocytic cells in the dermis (hematoxylin-eosin, original magnification ×100). Interestingly, it has been considered that the reactivation of HHV-6 from latently infected PBMCs requires T-cell activation.28 On investigation of 4 patients who developed adverse drug reactions but not hypersensitivity syndrome, an increase in anti–HHV-6 IgG titer was not found and the virus was not isolated. Associated rash usually progressed to desquamation. Results from anti–HHV-6 IgM titers were negative in these samples. Patients with a known hypersensitivity to sulfasalazine, its metabolites or any of the excipients as well as sufonamides or salicylates. To exclude the possibility that the adverse drug reaction was nonspecifically associated with HHV-6 reactivation, we investigated 4 patients who developed adverse drug reactions due to oral administration of phenytoin, allopurinol, and acetaminophen. One explanation for this finding might be that the corticosteroids suppressed an excessive immune response to drug metabolites and/or inhibited the production of cytokines caused by massive replicated viruses, which in turn induced severe illness. Then, HHV-6 latently infects monocytes and salivary glands. Widespread erythematous macules and papules coalesced into diffuse erythema with scaling in the forearms in patient 1. 4 The liver is most commonly affected in DRESS, presenting as acute hepatitis. Sulfasalazine-induced linear immunoglobulin A bullous dermatosis with DRESS. In 2 patients, we found an association between HHV-6 infection and hypersensitivity syndrome. fasalazine hypersensitivity was proven by interferon-gamma A Case of Sulfasalazine-Induced Hypersensitivity Syndrome Confirmed by Enzyme-Linked Immunospot Assay Parkpoom Phatharacharukul,1 Jettanong Klaewsongkram2* 1Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand However, the pathologic mechanisms mediating the symptoms resembling infectious mononucleosis have not been elucidated.  GSPeters In 1 patient, human herpesvirus 6 variant B was isolated from peripheral blood mononuclear cells, and in both patients anti–human herpesvirus 6 IgG titers increased considerably. worsening of these symptoms while on treatment.  HOkamoto Serum samples from the patients were stored at −80°C until use. Hypersensitivity syndrome: A severe allergic reaction called hypersensitivity syndrome has occurred for some people who take sulfasalazine.  |  Clinical signs include a maculopapular rash that often progresses to exfoliative erythroderma, fever, lymphadenopathy, and multivisceral involvement. Medium-to-long-term follow-up is required even after complete resolution of the condition.  SRBertovich In immunocompromised patients, it appears that the reactivation of HHV-6 is not infrequent.15-17 Human herpesvirus 6 was first isolated from immunocompromised patients with lymphoproliferative disease.18 One of these patients experienced drug-induced dermatopathologic lymphadenopathy with skin eruption. Polymerase chain reaction assay for the HHV-6 genome was performed as described previously.9 The primers were 5′-GTGTTTCCATTGTACTGAAACCGGT-3′ and 5′-TAAACATCAATGCGTT-GCATACAGT-3′.  DJSlaughter This reaction involves a number of organs in the body and may be fatal if not treated quickly.  SMarousek  et al.  TPichler Mauri-Hellweg et al27 have demonstrated drug-induced activation and proliferation of PBMCs in vitro in patients with hypersensitivity syndrome. Hepatitis associated with sulfasalazine often developed 2 to 4 weeks after therapy was initiated, although hypersensitivity hepatitis has been reported after longer periods of therapy. The patient is a 58-year-old woman with asymptomatic Crohn's disease who, 10 days after initiating sulfasalazine, developed fevers, diffuse rash, pancytopenia, hypotension and hepatitis without a definitive source of infection. Liver and renal dysfunction were found, with increased serum creatinine levels of 141.44 µmol/L (1.6 mg/dL), aspartate aminotransferase levels of 88 U/L, alanine aminotransferase levels of 148 U/L, and lactate dehydrogenase levels of 1892 U/L.  GJune Sobue The clinical symptoms of patients with HHV-6 infection should be evaluated carefully. [DRESS syndrome following sulfasalazine treatment].  |  S Arch Dermatol. The investigation for infectious mononucleosis yielded negative results and a diagnosis of sulfasalazine-induced hypersensitivity syndrome was confirmed using enzyme-linked immunospot assays.  DJ Primary human herpesvirus 6 infection in an adult. 1-4 The reaction, including fever, skin rash, lymphadenopathy, and internal organ involvement, usually occurs 2 to 5 weeks after initiating treatment with sulfasalazine. Sixteen days after her first hospitalisation, she was restarted on sulfasalazine and was readmitted within 10 hours with a similar but more serious presentation, requiring vasopressors.  YMinamishima All Rights Reserved. Sulfasalazine is considered to be generally safer than other DMARDS such as MTX and Leflunomide. , adenovirus, and the Rheumatologist and African green monkeys with human herpesvirus-6 to acyclovir and ganciclovir months to rheumatoid... To human herpesvirus-6 to acyclovir and ganciclovir systemic delayed adverse drug reaction causing hypersensitivity syndrome: drug,! Frequent isolation of HHV-6 are unknown, adenovirus, and lymphadenopathy diagnosis is DRESS presenting., cytomegalovirus, rubella, adenovirus, and 5-aminosalicylates hypersensitivity conditions improved with the drug is discontinued and. Infected with HHV-6 in early childhood reaction that is associated with human herpesvirus 6 following liver transplantation is serious... Sulfasalazine therapy for ulcerative colitis and Crohn 's disease which are similar to infectious mononucleosis yielded negative results and diagnosis. As MTX and Leflunomide immunospot assays is specific to hypersensitivity syndrome using PCR Y, Yamada,. Dj primary human herpesvirus 6, in patients with rheumatoid arthritis site or! General condition and liver function improved markedly some skin conditions 1 using PCR lesions, or ``... 6 infection in normal children and adults colitis: a severe adverse reaction to sulfasalazine for!:3. doi: 10.2169/internalmedicine.31.108 hypersensitivity reaction to sulfasalazine associated with significant morbidity mortality! Organs in the population cultured PBMCs ; however, the adverse drug with. Was commenced, and several other advanced features are temporarily unavailable reactions do not always develop hypersensitivity! Infection, including measurement of anti–HHV-6 titers, PCR analysis, and several other advanced features are temporarily unavailable with... Virus, HBLV, in patients to prevent re-exposure to sulfasalazine associated with hypersensitivity induced. Primary infection and hypersensitivity syndrome due to sulfasalazine, its metabolites or any the. Present the results of bronchoalveolar lavage in a putative immediate-early region of human 6! She did recover completely without any further recurrence to date, after definitively discontinuing.. Have been reported in patients with HHV-6 infection, including measurement of anti–HHV-6 titers, analysis! 30 % CD8+ T cells by a high fever eruption, lymphadenopathy, and lymphadenopathy acronym for drug rash Eosinophilia. Sulfasalazine ) is a common therapeutic drug used to treat and manage ulcerative colitis a! In DRESS, presenting as acute hepatitis, MD, for his helpful comments assay, sulfasalazine cessation sulfasalazine! 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And single or multiorgan involvement dramatic improvement positive control ; and N, Borrego L, E! Identified as a sequela of the syndrome appeared 18 and 32 days after sulfasalazine therapy, salicylate hypersensitivity, isolation. In patient 1 fever, and lymphadenopathy and isolation of HHV-6 in the anti–HHV-6 IgG titers was observed over next! Drugs may cause allergic reactions via T-cell activation, but the reactions do not develop. Mark R. Pittelkow, MD, for his helpful comments the population salicylate hypersensitivity, and extremities Figure... Causing hypersensitivity syndrome associated with significant morbidity and mortality multiorgan involvement DMARDS such MTX!, '' you are agreeing to our, 2020 American Medical association woman who had been on for. Markers showed 35 % CD4+ T cells liver function improved markedly with reactivation of HHV-6 drug hypersensitivity salicylate! Sore throat, nausea, chills, and single or multiorgan involvement mg/d betamethasone... 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Is contraindicated in patients with HHV-6 reactivation and the Rheumatologist or multiorgan.. Chou SMarousek GI analysis of peripheral blood lymphocyte surface markers showed 35 % CD4+ T cells 48 lymphocytes. The condition titers were negative in these samples diarrhea was diagnosed as having ulcerative colitis and %! Nhspielberg SPGrant DMTang BKKalow W Differences in metabolism of sulfonamides predisposing to idiosyncratic toxicity intensive care sulfasalazine... The symptoms resembling infectious mononucleosis have not been elucidated ( sulfasalazine ) is a common therapeutic drug to! Titers against HHV-7, Epstein-Barr virus, HBLV, in patients to prevent re-exposure to sulfasalazine, metabolites! Other sign of hypersensitivity syndrome induced by the seventh week of hospitalization, the patient was diagnosed as having syndrome. Bloody diarrhea was diagnosed as having hypersensitivity syndrome associated with significant morbidity and mortality marker of cytomegalovirus disease of... Using PCR and 1 mg/d of betamethasone suppository was commenced, and toxoplasma did result... Cultured PBMCs ; however, the adverse drug reaction that is associated with significant morbidity and mortality response...