Occupational trichloroethylene hypersensitivity syndrome: Human herpesvirus 6 reactivation and rash phenotypes

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• 作者：Michihiro Kamijima ; Hailan Wang ; Osamu Yamanoshita ; Yuki Ito ; Lihua Xia ; Yukie Yanagiba ; Cishan Chen ; Ai Okamura ; Zhenlie Huang ; Xinxiang Qiu ; Xiangrong Song ; Tingfeng Cai ; Lili Liu ; Yichen Ge ; Yingyu Deng ; Hisao Naito ; Tetsushi Yoshikawa ; Mikiko Tohyama ; Laiyu Li ; Hanlin Huang ; et al.
• 关键词：DIHS ; drug-induced hypersensitivity syndrome ; DRESS ; drug reaction with eosinophilia and systemic symptoms ; ED ; exfoliative dermatitis ; EM ; erythema multiforme ; HHV6 ; human herpesvirus 6 ; IFN-纬 ; interferon gamma ; IL ; interleukin ; LOQ ; limit of quantification ; PBMC ; peripheral blood mononuculear cell ; SD ; standard deviation ; TCA ; trichloroacetic acid ; TCE ; trichloroethylene ; TEN ; toxic epidermal necrolysis ; TNF-伪 ; tumor necrosis factor alpha
• 刊名：Journal of Dermatological Science
• 出版年：December, 2013
• 年：2013
• 卷：72
• 期：3
• 页码：218-224
• 全文大小：1126 K

文摘

Background

Trichloroethylene (TCE) is an industrial solvent which can cause severe generalized dermatitis, i.e., occupational TCE hypersensitivity syndrome. Reactivation of latent human herpesvirus 6 (HHV6) can occur in such patients, which has made TCE known as a causative chemical of drug-induced hypersensitivity syndrome (DIHS).

Objective

This study aimed to clarify HHV6 status, cytokine profiles and their association with rash phenotypes in patients with TCE hypersensitivity syndrome.

Methods

HHV6 DNA copy numbers, anti-HHV6 antibody titers, and cytokines were measured in blood prospectively sampled 5-7 times from 28 hospitalized patients with the disease.

Results

The patients (19 had exfoliative dermatitis (ED) and 9 had non-ED type rash) generally met the diagnostic criteria for DIHS. Viral reactivation defined as increases in either HHV6 DNA (鈮?00 genomic copies/10⁶ peripheral blood mononuclear cells) or antibody titers was identified in 24 (89%) patients. HHV6 DNA, tumor necrosis factor (TNF)-伪, interferon (IFN)-纬, interleukin (IL)-5, IL-6 and IL-10 concentrations were remarkably higher in the patients than in the healthy workers (p < 0.01). Positive correlations between HHV6 DNA, TNF-伪, IFN-纬, IL-6 and IL-10 were significant (p < 0.05) except for that between HHV6 DNA and IFN-纬. An increase in HHV6 DNA was positively associated with an increase in TNF-伪 on admission (p < 0.01). HHV6 DNA, the antibody titers, TNF-伪 and IL-10 concentrations were significantly higher in ED than in the non-ED type (p < 0.05).

Conclusion

Reactivated HHV6 and the increased cytokines could be biomarkers of TCE hypersensitivity syndrome. The higher-level reactivation and stronger humoral responses were associated with ED-type rash.