Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate

Abstract Background Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important adverse reaction caused by a few drugs. Reactivation of human herpesvirus 6 (HHV-6) is known to be associated with its pathogenesis. DIHS occasiona...

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Autores principales:	Yutaka Muto, Naoyuki Kuse, Minoru Inomata, Nobuyasu Awano, Mari Tone, Kohei Takada, Kazushi Fujimoto, Yuan Bae, Toshio Kumasaka, Takehiro Izumo
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Drug-induced hypersensitivity syndrome Drug reaction with eosinophilia and systemic symptoms Interstitial lung disease Cryobiopsy Case report Diseases of the respiratory system RC705-779
Acceso en línea:	https://doaj.org/article/f1f0d8a714f345a48745d3b613ca406d
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spelling	oai:doaj.org-article:f1f0d8a714f345a48745d3b613ca406d2021-11-14T12:37:26ZDrug-induced hypersensitivity syndrome caused by minodronic acid hydrate10.1186/s12890-021-01709-x1471-2466https://doaj.org/article/f1f0d8a714f345a48745d3b613ca406d2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12890-021-01709-xhttps://doaj.org/toc/1471-2466Abstract Background Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important adverse reaction caused by a few drugs. Reactivation of human herpesvirus 6 (HHV-6) is known to be associated with its pathogenesis. DIHS occasionally manifests as pulmonary lesions with a variety of imaging findings. Case presentation An 83-year-old woman started taking minodronic acid hydrate 5 years before admission. She noticed a generalized skin rash 44 days before admission and started oral betamethasone-d-chlorpheniramine maleate combination tablets for allergic dermatitis. She developed a fever and cough in addition to the rash, and was referred to our hospital. Laboratory data showed a high level of eosinophils and liver and biliary enzymes. Computed tomography (CT) studies revealed bilateral diffuse ground-glass opacities with ill-defined centrilobular nodules from the central to peripheral regions of the lungs. Transbronchial lung cryobiopsy specimens showed that lymphocyte infiltration was observed in the alveolar walls and fibrinous exudates and floating macrophages in the alveolar lumina. Immunohistochemistry of biopsy specimens showed more CD4+ lymphocytes than CD8+ lymphocytes, while few Foxp3+ lymphocytes were recognized. The serum anti-HHV-6 immunoglobulin G titer increased at 3 weeks after the first test. Based on these findings, we diagnosed her with DIHS. We continued care without using corticosteroids since there was no worsening of breathing or skin condition. Eventually, her clinical symptoms chest CT had improved. Minodronic acid hydrate was identified as the culprit drug based on the positive results of the patch test and drug-induced lymphocyte stimulation test. Conclusions We described the first case of DIHS caused by minodronic acid hydrate. Lung lesions in DIHS can present with bilateral diffuse ground-glass opacities and ill-defined centrilobular nodules on a CT scan during the recovery phase. Clinicians should be aware of DIHS, even if patients are not involved with typical DIHS/DRESS-causing drugs.Yutaka MutoNaoyuki KuseMinoru InomataNobuyasu AwanoMari ToneKohei TakadaKazushi FujimotoYuan BaeToshio KumasakaTakehiro IzumoBMCarticleDrug-induced hypersensitivity syndromeDrug reaction with eosinophilia and systemic symptomsInterstitial lung diseaseCryobiopsyCase reportDiseases of the respiratory systemRC705-779ENBMC Pulmonary Medicine, Vol 21, Iss 1, Pp 1-6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Drug-induced hypersensitivity syndrome Drug reaction with eosinophilia and systemic symptoms Interstitial lung disease Cryobiopsy Case report Diseases of the respiratory system RC705-779
spellingShingle	Drug-induced hypersensitivity syndrome Drug reaction with eosinophilia and systemic symptoms Interstitial lung disease Cryobiopsy Case report Diseases of the respiratory system RC705-779 Yutaka Muto Naoyuki Kuse Minoru Inomata Nobuyasu Awano Mari Tone Kohei Takada Kazushi Fujimoto Yuan Bae Toshio Kumasaka Takehiro Izumo Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
description	Abstract Background Drug-induced hypersensitivity syndrome (DIHS)/drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an important adverse reaction caused by a few drugs. Reactivation of human herpesvirus 6 (HHV-6) is known to be associated with its pathogenesis. DIHS occasionally manifests as pulmonary lesions with a variety of imaging findings. Case presentation An 83-year-old woman started taking minodronic acid hydrate 5 years before admission. She noticed a generalized skin rash 44 days before admission and started oral betamethasone-d-chlorpheniramine maleate combination tablets for allergic dermatitis. She developed a fever and cough in addition to the rash, and was referred to our hospital. Laboratory data showed a high level of eosinophils and liver and biliary enzymes. Computed tomography (CT) studies revealed bilateral diffuse ground-glass opacities with ill-defined centrilobular nodules from the central to peripheral regions of the lungs. Transbronchial lung cryobiopsy specimens showed that lymphocyte infiltration was observed in the alveolar walls and fibrinous exudates and floating macrophages in the alveolar lumina. Immunohistochemistry of biopsy specimens showed more CD4+ lymphocytes than CD8+ lymphocytes, while few Foxp3+ lymphocytes were recognized. The serum anti-HHV-6 immunoglobulin G titer increased at 3 weeks after the first test. Based on these findings, we diagnosed her with DIHS. We continued care without using corticosteroids since there was no worsening of breathing or skin condition. Eventually, her clinical symptoms chest CT had improved. Minodronic acid hydrate was identified as the culprit drug based on the positive results of the patch test and drug-induced lymphocyte stimulation test. Conclusions We described the first case of DIHS caused by minodronic acid hydrate. Lung lesions in DIHS can present with bilateral diffuse ground-glass opacities and ill-defined centrilobular nodules on a CT scan during the recovery phase. Clinicians should be aware of DIHS, even if patients are not involved with typical DIHS/DRESS-causing drugs.
format	article
author	Yutaka Muto Naoyuki Kuse Minoru Inomata Nobuyasu Awano Mari Tone Kohei Takada Kazushi Fujimoto Yuan Bae Toshio Kumasaka Takehiro Izumo
author_facet	Yutaka Muto Naoyuki Kuse Minoru Inomata Nobuyasu Awano Mari Tone Kohei Takada Kazushi Fujimoto Yuan Bae Toshio Kumasaka Takehiro Izumo
author_sort	Yutaka Muto
title	Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
title_short	Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
title_full	Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
title_fullStr	Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
title_full_unstemmed	Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
title_sort	drug-induced hypersensitivity syndrome caused by minodronic acid hydrate
publisher	BMC
publishDate	2021
url	https://doaj.org/article/f1f0d8a714f345a48745d3b613ca406d
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Drug-induced hypersensitivity syndrome caused by minodronic acid hydrate

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