title: Drug eruption caused by azathioprine: value of using the drug-induced lymphocytes stimulation test for diagnosis.
abstract: Azathioprine (AZA) is an immunosuppressant commonly used for organ transplantation and autoimmune diseases. Allergic side effects of AZA are rare, and reported allergic skin eruptions from AZA are very limited in Japan. We report AZA-induced drug eruption that developed in two cases of systemic scleroderma with polymyositis. One case presented with Stevens-Johnson syndrome, and the other had systemic papular erythema. The stimulation indices of the drug-induced lymphocyte stimulation test (DLST) for AZA in these two patients were as high as 2,180% and 430%, respectively, but those of healthy volunteers were under 120% without nonspecific suppression of lymphocyte proliferation. Other drugs used simultaneously were ruled out by patch and challenge tests. The challenge test for Stevens-Johnson syndrome type drug allergy is very risky. DLST is a good diagnostic tool for AZA allergy, especially for severe drug allergy cases.
authors.affiliation: Department of Dermatology, Mie University, Faculty of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Mori
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Masato
authors.initials: M
authors.lastname: Kaketa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Tamada
authors.forename: Arata
authors.initials: A
authors.lastname: Hakamada
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Isoda
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Yamanishi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Mizutani
mesh_terms: D001379:Azathioprine / Q000009:adverse effects*; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008213:Lymphocyte Activation; D008875:Middle Aged; D017285:Polymyositis / Q000188:drug therapy; D012595:Scleroderma, Systemic / Q000188:drug therapy
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine