Altered T cell and monocyte subsets in prolonged immune reconstitution inflammatory syndrome related with DRESS (drug reaction with eosinophilia and systemic symptoms)
- Authors
- Kang, Sung-Yoon; Kim, Jihyun; Ham, Jongho; Cho, Sang-Heon; Kang, Hye-Ryun; Kim, Hye Young
- Issue Date
- Jan-2020
- Publisher
- ASIA PACIFIC ASSOC ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY
- Keywords
- DRESS syndrome; Allopurinol; Herpesviruses; Immune reconstitution
- Citation
- ASIA PACIFIC ALLERGY, v.10, no.1
- Journal Title
- ASIA PACIFIC ALLERGY
- Volume
- 10
- Number
- 1
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/26175
- DOI
- 10.5415/apallergy.2020.10.e2
- ISSN
- 2233-8276
- Abstract
- Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse reaction involving various internal organs. Flare-ups after recovery from the initial presentation of DRESS are caused by relapse of drug-induced T-cell-mediated reactions. However, the specific underlying mechanism is unclear. Here, we report a case of a 60-year-old man with allopurinol-induced DRESS who suffered recurrent episodes of generalized rash with eosinophilia, which mimicked immune reconstitution inflammatory syndrome. Analysis of immunological profiles revealed that the percentages of T lymphocytes and regulatory T cells in the patient with DRESS were higher than those in healthy controls. In addition, there was a notable change in the subtype of monocytes in the patient with DRESS; the percentage of nonclassical monocytes increased, whereas that of classical monocytes decreased. Upon viral infection, nonclassical monocytes exhibited strong proinflammatory properties that skewed the immune response toward a Th2 profile, which was associated with persistent flare-ups of DRESS. Taken together, the results increase our understanding of the pathogenesis of DRESS as they suggest that expansion of nonclassical monocytes and Th2 cells drives disease pathogenesis.
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