Case Reports
doi: 10.1002/ccr3.3218. eCollection 2020 Dec.Trimethoprim-induced drug reaction with eosinophilia and systemic symptoms (DRESS) associated with reactivation of human herpes virus-6 (HHV-6) leading to acute liver failure
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- PMID:33363781
- PMCID: PMC7752394
- DOI: 10.1002/ccr3.3218
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Case Reports
Trimethoprim-induced drug reaction with eosinophilia and systemic symptoms (DRESS) associated with reactivation of human herpes virus-6 (HHV-6) leading to acute liver failure
Mohsan Subhani et al. Clin Case Rep..
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Abstract
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can have insidious symptoms which may lead to acute liver failure and death. Prompt recognition, stopping offending drug, and initiating corticosteroid are the mainstay of treatment. Early involvement of a specialist liver unit is vital.
Keywords: acute liver failure; drug reaction with eosinophilia and systemic symptoms; drug‐induced liver injury; human herpes virus‐6; jaundice; liver transplant.
© 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
Conflict of interest statement
None declared.
Figures
CT Abdomen: Lymphadenopathy with marked hepatosplenomegaly
Liver histology: Subacute liver failure secondary to submassive hepatocellular necrosis. Representative macroscopic and microscopic images: A, Representative macroscopic section of the explanted liver. The liver is collapsed (723 g) with a single small area of residual parenchyma (inset), cholestatic (marked with arrows). B, Low magnification microscopy of this area demonstrates centrilobular‐based hepatocellular loss with bridging hepatocyte loss and collapse (*), in contrast with the total absence of hepatocytes observed in most of the liver tissue. Hepatocyte specific antigen immunostaining highlights the map‐like appearance of the area, 20×. C, Higher magnification of a centrilobular area, with perivenular confluent hepatocyte loss (*). Portal tracts (PT) show overall mild inflammation, with predominantly lymphocytes and occasional plasma cells and eosinophils. Residual hepatocytes show acute bilirubinostasis (arrows), H&E, 200×. D, Sirius red stain shows, no evidence of significant fibrosis, only collapse 200×
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