{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T03:39:19Z","timestamp":1787974759316,"version":"build-2784847793"},"reference-count":45,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a severe adverse event (mortality of 10%). Its pathophysiology involves herpesviruses, particularly HHV\u20106, but the exact mechanisms are still poorly understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe severe cases of DRESS and especially their association with herpesvirus reactivation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was a multicentre case series conducted between 2007 and 2021 at five University Hospital Centres in France. The study included patients who had severe DRESS, which was defined as death, transfer to the intensive care unit (ICU), or severe damage to internal organs. We excluded patients without blood PCR sample, without a drug formally attributed or with RegiSCAR score\u2009&lt;\u20096. We collected data on severity, causative drug, associated visceral damage and results of viral blood PCRs. HHV\u20106 reactivation was studied in skin biopsies by detection of small non\u2010coding transcripts (HHV\u20106 miR\u2010aU14) and a late viral protein (GP82\/105).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010two patients were included (29 female, median age 62, interquartile range (IQR) [37;72]). Eight patients (15%) died, 13 (27%) were admitted to ICU. Most patients (<jats:italic>n<\/jats:italic>\u2009=\u200934; 65%) had multisystem involvement: most frequent was liver (<jats:italic>n<\/jats:italic>\u2009=\u200946; 88%), then renal failure (<jats:italic>n<\/jats:italic>\u2009=\u200924; 46%). Forty patients (77%) had at least one blood viral reactivation among HHV\u20106, EBV or CMV, of which 21 (53%) had at least two. Median time of blood HHV\u20106 reactivation was 24\u2009days (IQR [20;35]). HHV\u20106 reactivation was demonstrated in 15 out of 20 skin biopsies, with a median time of 11\u2009days [9;17].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We confirmed the high rate of HHV\u20106 reactivation in severe DRESS and demonstrated cutaneous HHV\u20106 reactivation using small non\u2010coding transcripts (HHV\u20106 miR\u2010aU14), which preceded viral PCR positivity in blood. These results suggest that HHV\u20106 reactivation during DRESS may start in skin. Furthermore, search for miR\u2010aU14 in skin biopsy could become a useful diagnostic tool for early detection of HHV\u20106 reactivation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jdv.19425","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T12:27:34Z","timestamp":1692448054000},"page":"2550-2557","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Retrospective study on the association of human herpesvirus reactivation with severe <scp>DRESS<\/scp>: A description of blood and skin reactivations"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2350-3212","authenticated-orcid":false,"given":"C.","family":"Marcombes","sequence":"first","affiliation":[{"name":"Department of Dermatology AP\u2010HP, Bichat Hospital  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5383-7096","authenticated-orcid":false,"given":"S.","family":"Ingen\u2010Housz\u2010Oro","sequence":"additional","affiliation":[{"name":"Department of Dermatology AP\u2010HP, Henri\u2010Mondor Hospital  Cr\u00e9teil France"},{"name":"Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL  Cr\u00e9teil France"},{"name":"Epiderme, Paris Est Cr\u00e9teil University  Cr\u00e9teil France"},{"name":"FISARD Study Group (French Investigators for Skin Adverse Reactions to Drugs) of the French Dermatology Society  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8930-1042","authenticated-orcid":false,"given":"F.","family":"Dezoteux","sequence":"additional","affiliation":[{"name":"FISARD Study Group (French Investigators for Skin Adverse Reactions to Drugs) of the French Dermatology Society  Paris France"},{"name":"Department of Dermatology CHU Lille, Univ Lille, INSERM U1286, Lille Inflammation Translational Research Institute (INFINITE)  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Staumont\u2010Sall\u00e9","sequence":"additional","affiliation":[{"name":"FISARD Study Group (French Investigators for Skin Adverse Reactions to Drugs) of the French Dermatology Society  Paris France"},{"name":"Department of Dermatology CHU Lille, Univ Lille, INSERM U1286, Lille Inflammation Translational Research Institute (INFINITE)  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3679-6613","authenticated-orcid":false,"given":"B.","family":"Milpied","sequence":"additional","affiliation":[{"name":"Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL  Cr\u00e9teil France"},{"name":"FISARD Study Group (French Investigators for Skin Adverse Reactions to Drugs) of the French Dermatology Society  Paris France"},{"name":"Department of Dermatology UHC Bordeaux  Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Tetart","sequence":"additional","affiliation":[{"name":"Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL  Cr\u00e9teil France"},{"name":"FISARD Study Group (French Investigators for Skin Adverse Reactions to Drugs) of the French Dermatology Society  Paris France"},{"name":"Department of Dermatology UHC Rouen  Rouen France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"de Prost","sequence":"additional","affiliation":[{"name":"Reference Center for Toxic Bullous Dermatoses and Severe Drug Reactions TOXIBUL  Cr\u00e9teil France"},{"name":"Intensive Care Unit AP\u2010HP, Henri\u2010Mondor Hospital  Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Fourati","sequence":"additional","affiliation":[{"name":"Virology Department AP\u2010HP, Henri\u2010Mondor Hospital  Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0111-7422","authenticated-orcid":false,"given":"N.","family":"Ortonne","sequence":"additional","affiliation":[{"name":"Department of Pathology Henri\u2010Mondor Hospital  Cr\u00e9teil France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Kasimir","sequence":"additional","affiliation":[{"name":"Institute for Virology and Immunobiology Julius\u2010Maximilians\u2010Universit\u00e4tW\u00fcrzburg  W\u00fcrzburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. 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