# Chronic and Acute Drug-Induced Hypersensitivity Syndrome in a Rural Patient With Cytomegalovirus Infection: A Case Report

## TL;DR

A 50-year-old man with a long-term viral infection developed a drug-induced hypersensitivity syndrome, highlighting the challenges of diagnosing and managing this condition in rural areas.

## Contribution

This case report highlights the rare presentation of chronic and acute drug-induced hypersensitivity syndrome in a patient with cytomegalovirus infection.

## Key findings

- The patient's symptoms worsened after ampicillin treatment and improved after discontinuation and corticosteroid therapy.
- Hypersensitivity to both ampicillin and allopurinol was confirmed via a drug-induced lymphocyte stimulation test.
- The case emphasizes the need for high suspicion of DIHS in patients with chronic lymphadenopathy and recent drug exposure.

## Abstract

A 50-year-old man presented with fever and a generalized rash, with chronic fatigue and lymphadenopathy for a year and a half. Initial tests ruled out lymphoproliferative disorders, showing reactive hyperplasia and cytomegalovirus. Symptoms worsened after ampicillin treatment, leading to suspected drug-induced hypersensitivity syndrome (DIHS). Upon admission, amoxicillin was discontinued, and prednisolone and antiviral treatment were initiated. The patient's condition improved with this therapy. A drug-induced lymphocyte stimulation test confirmed hypersensitivity to both ampicillin and allopurinol. This case illustrates the diagnostic challenge of chronic and acute DIHS because of the rare presentation. It underscores the need for high suspicion of DIHS in patients with chronic lymphadenopathy and fatigue, particularly with recent drug exposure. Effective management involves recognizing symptoms, withdrawing the offending drug, and using corticosteroids. Viral infections like cytomegalovirus can complicate DIHS diagnosis and treatment, necessitating a comprehensive approach. This case highlights the importance of considering DIHS in differential diagnoses and the complexities of managing it alongside co-infections in rural healthcare settings.