Sano S, Ueno H, Yamagami K, Yakushiji Y, Isaka Y, Kawasaki I, Takemura M, Inoue T, Hosoi M. Isolated ileal perforation due to cytomegalovirus reactivation during management of terbinafine hypersensitivity. World J Gastroenterol 2010; 16(26): 3339-3342 [PMID: 20614493 DOI: 10.3748/wjg.v16.i26.3339]
Corresponding Author of This Article
Keiko Yamagami, MD, Department of Metabolism and Endocrinology, Osaka City General Hospital, 2-13-22, Miyakojima-hon-dori, Miyakojima-ku, Osaka 534-0021, Japan. yamasanz@qb3.so-net.ne.jp
Article-Type of This Article
Case Report
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Soichi Sano, Keiko Yamagami, Department of Internal Medicine, Osaka City General Hospital, Osaka 534-0021, Japan
Hiroki Ueno, Keiko Yamagami, Yosuke Yakushiji, Yoshihiro Isaka, Isao Kawasaki, Masayuki Hosoi, Department of Metabolism and Endocrinology, Osaka City General Hospital, Osaka 534-0021, Japan
Masashi Takemura, Department of Gastrointestinal Surgery, Osaka City General Hospital, Osaka 534-0021, Japan
Takeshi Inoue, Department of Pathology, Osaka City General Hospital, Osaka 534-0021, Japan
Author contributions: Sano S, Ueno H, Yamagami K and Yakushiji Y were involved in the total treatment of the patient; Isaka Y and Kawasaki I were involved in the diabetic treatment of the patient; Takemura M performed surgery; Inoue T contributed to the pathological examination; Sano S and Hosoi M wrote the paper.
Correspondence to: Keiko Yamagami, MD, Department of Metabolism and Endocrinology, Osaka City General Hospital, 2-13-22, Miyakojima-hon-dori, Miyakojima-ku, Osaka 534-0021, Japan. yamasanz@qb3.so-net.ne.jp
Telephone: +81-6-69291221 Fax: +81-6-69291091
Received: December 30, 2009 Revised: March 12, 2010 Accepted: March 19, 2010 Published online: July 14, 2010
Abstract
We report a case of 71-year-old man who developed a hypersensitivity syndrome associated with terbinafine. He was placed on terbinafine (250 mg/d) for the treatment of tinea pedis due to diabetes mellitus. Following the treatment with terbinafine, he developed drug-induced hypersensitivity syndrome (DIHS). Systemic corticosteroid led to transient improvement of his clinical manifestations. Three months after disease onset, he presented with panperitonitis due to ileal perforation, and underwent an emergency operation. The affected ileum was resected and ileostomy was performed in the terminal ileum. Cytomegalovirus (CMV)-specific IgG antibodies were significantly increased, high-titer CMV antigenemia was detected, and pathological examination of the resected ileum confirmed CMV infection. Based on these observations, we strongly recommend that physicians monitor reactivation of the family of herpesvirus other than herpesvirus 6, to manage DIHS properly.
