Bronchoscopic Investigation of Atypical Drug-induced Hypersensitivity Syndrome Showing Viral Lung Involvement

Isano Hase; Hiroaki Arakawa; Hideo Sakuma; Fumio Kaneko; Yuzuru Watanabe; Koichi Fujiu; Hideaki Miyamoto; Yoshiki Ishii

doi:10.2169/internalmedicine.55.6347

CASE REPORTS

Bronchoscopic Investigation of Atypical Drug-induced Hypersensitivity Syndrome Showing Viral Lung Involvement

Isano Hase, Hiroaki Arakawa, Hideo Sakuma, Fumio Kaneko, Yuzuru Watanabe, Koichi Fujiu, Hideaki Miyamoto, Yoshiki Ishii

Author information

Isano Hase
Department of Respiratory Disease, Southern Tohoku General Hospital, Japan
Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Japan
Hiroaki Arakawa
Department of Radiology, Dokkyo Medical University, Japan
Hideo Sakuma
Department of Pathology, Southern Tohoku General Hospital, Japan
Fumio Kaneko
Department of Dermatology, Southern Tohoku General Hospital, Japan
Yuzuru Watanabe
Department of General Thoracic Surgery, Southern Tohoku General Hospital, Japan
Koichi Fujiu
Department of General Thoracic Surgery, Southern Tohoku General Hospital, Japan
Hideaki Miyamoto
Department of General Thoracic Surgery, Southern Tohoku General Hospital, Japan
Yoshiki Ishii
Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University, Japan

Keywords: drug-induced hypersensitivity syndrome (DIHS), lung, bronchus, reactivation of virus, CD8⁺ T lymphocyte

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 18 Pages 2691-2696

DOI https://doi.org/10.2169/internalmedicine.55.6347

Details

Abstract

We herein report a case of atypical drug-induced hypersensitivity syndrome (DIHS) involving serological reactivation of cytomegalovirus induced by carbamazepine with pulmonary and skin manifestations. These lesions were not present on admission, but developed on virus reactivation as indicated by the presence of inclusion bodies and multinucleated giant cells in alveolar cells with CD8⁺ T lymphocyte infiltration on a transbronchial lung biopsy. Although the precise mechanism of DIHS remains unknown, this case suggests the crucial role of viral reactivation in pulmonary lesions in DIHS.

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