title: Acute generalized exanthematous pustulosis due to sulfamethoxazol with positive lymphocyte transformation test (LTT).
abstract: We studied an acute generalized exanthematous pustulosis (AGEP) due to sulfamethoxazol in a 48-year-old woman with unusual findings in allergy testing. The histological picture provided evidence for a pustular drug eruption and leukocytoclastic vasculitis. Skin testing with sulfamethoxazol was negative for immediate-type reaction (scratch test) and delayed-type reaction (epicutaneous testing). A lymphocyte transformation test (LTT) showed a significant lymphocyte stimulation (stimulation index 5.04/2.61) toward sulfamethoxazol (200/100 mg/ml) by measuring the rate of built-in tritium-thymidine in the DNS of the patients lymphocytes, implicating a drug-specific hypersensibility of lymphocytes; we could be dealing with a combined type III and IV reaction by Coombs and Gell in this case. LTT may play a possible role in the determination of drug allergy in AGEP despite negative skin testing.
authors.affiliation: Allergy Unit, Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland. markanliker@hotmail.com
authors.forename: Mark David
authors.initials: MD
authors.lastname: Anliker
authors.forename: Brunello
authors.initials: B
authors.lastname: Wüthrich
mesh_terms: D000287:Administration, Topical; D000890:Anti-Infective Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000627:therapeutic use; D003875:Drug Eruptions / Q000188:drug therapy / Q000209:etiology*; D005076:Exanthema / Q000139:chemically induced* / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D008213:Lymphocyte Activation; D008875:Middle Aged; D012882:Skin Tests; D013420:Sulfamethoxazole / Q000009:adverse effects / Q000494:pharmacology; D014295:Trimethoprim / Q000494:pharmacology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000139:chemically induced* / Q000188:drug therapy
chemical_list: D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D001623:Betamethasone; D014295:Trimethoprim; D013420:Sulfamethoxazole