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Three potential causative factors have been identified 1) a defect in drug metabolism resulting in the failure to eliminate toxic reactive intermediates, 2) reactivation of human herpesvirus 6 (HHV-6), human herpesvirus 7 (HHV-7), Epstein-Barr virus (EBV), or cytomegalovirus (CMV), which may serve as a trigger for the reaction, and 3) a genetic predisposition that alters immune response