Cytomegalovirus complications in drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms: importance of routine monitoring and early therapeutic intervention

Fatal outcomes in drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) are reported to be associated with cytomegalovirus (CMV) reactivation. However, CMV reactivation is observed not only in DIHS/DRESS but also in other diseases when high doses of corticosteroids are administered. Currently, it is difficult to distinguish whether CMV reactivation in DIHS/DRESS is caused by steroid-induced immunosuppression or the pathology of DIHS/DRESS. In this study, we describe the characteristic of CMV reactivation in patients with DIHS/DRESS (n = 22) by comparing the frequency of reactivation and its complications with those that occur in people with pemphigus vulgaris (PV) (n = 21) treated with high doses of corticosteroids. The frequency of CMV reactivation showed no difference between the DIHS/DRESS and PV groups. On the other hand, the frequency of CMV complications was higher in the DIHS than the PV group. Our data show the importance of monitoring for CMV complications, although CMV reactivation is not a unique consequence of DIHS/DRESS compared with other diseases treated with a high dose of corticosteroids.