D3.85 - Estrogen-Induced Drug Hypersensitivity Syndrome in a Patient with HHV-6 Reactivation

Introduction: A rare clinical case of drug-induced hypersensitivity syndrome (DIHS) in a 24-year-old female patient undergoing estrogen therapy led to admission to the intensive care unit with complaints of a generalized maculopapular rash, first manifested after 3 weeks of treatment with estrogen derivatives prescribed for the management of algomenorrhea.  There was no prior history of drug allergy.

Methods: The initial dermatological manifestations appeared in the décolleté region and subsequently disseminated to the face, abdomen, and extremities. Administration of antihistamines failed to elicit a response. 

Results: Laboratory Investigations revealed moderate eosinophilia (9%, 340 cells/μL) and an elevated erythrocyte sedimentation rate (ESR) of 28 mm/h. Liver function tests demonstrated significant elevations in transaminases (ALT 1400 U/L, AST 640 U/L). Abdominal ultrasonography identified moderate hepatomegaly, while echocardiography revealed mild pericarditis. The patient remained afebrile throughout the clinical course, and both viral hepatitis and autoimmune diseases were excluded .Further evaluation by quantitative polymerase chain reaction (PCR) analysis of peripheral blood detected human herpesvirus 6 (HHV-6) DNA at a concentration of 17,000 copies/mL, whereas Epstein-Barr virus (EBV) and HHV-7 DNA were not detected. The patient reported experiencing significant psychological stress following a recent bombing incident. Salivary cortisol levels were mildly elevated; immunological assessment revealed no evidence of immunodeficiency, and serological testing for HIV 1/2 antibodies was negative.

Therapeutic intervention consisted of pulse therapy with intravenous methylprednisolone at a dose of 500 mg twice daily, followed by oral methylprednisolone at 32 mg daily. The patient exhibited a favorable clinical response and was discharged in satisfactory condition on the tenth day of hospitalization.

Conclusion: This case highlights a rare instance of hypersensitivity to estrogen derivatives in the context of HHV-6 reactivation, accompanied by systemic manifestations including hepatitis and pericarditis.