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- Original article -
Drug Eruption Caused by Azathioprine: Value of Using the Drug-Induced Lymphocytes Stimulation Test for Diagnosis
Hitoshi Mori, Keiichi Yamanaka, Masato Kaketa, Kyoko Tamada, Arata Hakamada, Ken-ichi Isoda, Kiyofumi Yamanishi and Hitoshi Mizutani
Departments of Dermatology, Mie University, Faculty of Medicine, Tsu, Japan.
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.
key words: DLST; immunosuppressant; drug allergy; scleroderma
Received June 2, 2003; Accepted for publication May 10, 2004
Reprint requests to: Hitoshi Mizutani, M.D., Department of Dermatology, Mie University Faculty of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
J Dermatol 31 (9): 731-736, 2004
Japanese Dermatological Association
http://www.dermatol.or.jp
