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Case Reports
. 2010 Jul 14;16(26):3339-42.
doi: 10.3748/wjg.v16.i26.3339.

Isolated ileal perforation due to cytomegalovirus reactivation during management of terbinafine hypersensitivity

Soichi Sano  1 , Hiroki Ueno, Keiko Yamagami, Yosuke Yakushiji, Yoshihiro Isaka, Isao Kawasaki, Masashi Takemura, Takeshi Inoue, Masayuki Hosoi
Affiliations
Case Reports

Isolated ileal perforation due to cytomegalovirus reactivation during management of terbinafine hypersensitivity

Soichi Sano et al. World J Gastroenterol. .

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.

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Figures

Figure 1
Figure 1
Histological examination of perforated ileum. A: Perforated ileal lesion (hematoxylin and eosin stain) × 40; B: × 400; C: Cytomegalovirus infection was evident in the same lesion, by immunohistochemical staining with anti-cytomegalovirus antibody (× 200).
Figure 2
Figure 2
Abdominal computed tomography. A: Free-air, ascites; B: Swelling of the ileal loop.
See this image and copyright information in PMC

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