Journal
JOURNAL OF DERMATOLOGY
Volume 49, Issue 2, Pages 303-307Publisher
WILEY
DOI: 10.1111/1346-8138.16230
Keywords
cytomegalovirus; drug-induced hypersensitivity syndrome; drug reaction with eosinophilia and systemic symptoms; herpesvirus 6; mortality; steroid pulse therapy
Categories
Funding
- Ministry of Education, Culture, Sports, Science and Technology [24390276]
- Ministry of Health, Labour and Welfare of Japan
- Grants-in-Aid for Scientific Research [24390276] Funding Source: KAKEN
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Steroid pulse therapy for drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms carries risks of cytomegalovirus reactivation, persistency, and high mortality, compared to conventional treatment, while showing lower rates of herpesvirus 6 reactivation or type 1 diabetes. This suggests that the administration mode may differentially impact inflammatory responses and associated consequences. Based on the study findings, steroid pulse therapy should be avoided for these severe adverse reactions.
Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms is a life-threatening severe cutaneous adverse reaction, characterized by multiple organ involvement and reactivation of herpes viruses. Although the mainstay of treatment is a high dosage of corticosteroids delivered by pulse therapy or conventional oral administration, it remains debatable which mode is better. To clarify this issue, we reviewed publications in Japan of 299 cases of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms treated with corticosteroids, to evaluate safety concerns with regards to these two modes of treatment. As a result, we found that patients treated with pulse therapy more frequently suffered cytomegalovirus reactivation, persistency, and high mortality but less frequently experienced herpesvirus 6 reactivation or type 1 diabetes compared with those undergoing conventional treatment, suggesting that the administration mode may differentially modulate inflammatory responses toward distinct consequences. This is the first statistical analysis revealing that steroid pulse therapy frequently resulted in severe sequelae with high mortality. In terms of the risk of serious consequences, we consider that steroid pulse therapy should be eschewed for the treatment of drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms.
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