T-cell involvement in drug-induced acute generalized exanthematous pustulosis
Open Access
- 1 June 2001
- journal article
- Published by American Society for Clinical Investigation in JCI Insight
- Vol. 107 (11), 1433-1441
- https://doi.org/10.1172/jci12118
Abstract
Acute generalized exanthematous pustulosis (AGEP) is an uncommon eruption most often provoked by drugs, by acute infections with enteroviruses, or by mercury. It is characterized by acute, extensive formation of nonfollicular sterile pustules on erythematous background, fever, and peripheral blood leukocytosis. We present clinical and immunological data on four patients with this disease, which is caused by different drugs. An involvement of T cells could be implied by positive skin patch tests and lymphocyte transformation tests. Immunohistochemistry revealed a massive cell infiltrate consisting of neutrophils in pustules and T cells in the dermis and epidermis. Expression of the potent neutrophil-attracting chemokine IL-8 was elevated in keratinocytes and infiltrating mononuclear cells. Drug-specific T cells were generated from the blood and skin of three patients, and phenotypic characterization showed a heterogeneous distribution of CD4/CD8 phenotype and of T-cell receptor Vbeta-expression. Analysis of cytokine/chemokine profiles revealed that IL-8 is produced significantly more by drug-specific T cells from patients with AGEP compared with drug-specific T cells from patients that had non-AGEP exanthemas. In conclusion, our data demonstrate the involvement of drug-specific T cells in the pathomechanism of this rather rare and peculiar form of drug allergy. In addition, they indicate that even in some neutrophil-rich inflammatory responses specific T cells are engaged and might orchestrate the immune reaction.Keywords
This publication has 43 references indexed in Scilit:
- T Cells Isolated from Positive Epicutaneous Test Reactions to Amoxicillin and Ceftriaxone are Drug Specific and CytotoxicJournal of Investigative Dermatology, 2000
- Neutrophilic drug eruptionsClinics in Dermatology, 2000
- T cell involvement in persulfate triggered occupational contact dermatitis and asthmaAnnals of Allergy, Asthma & Immunology, 1999
- HLA-restricted, processing- and metabolism-independent pathway of drug recognition by human alpha beta T lymphocytes.JCI Insight, 1998
- Letters to DermatologyDermatology, 1998
- Allergic and autoimmune reactions to xenobiotics: how do they arise?Immunology Today, 1998
- Terbinafine-induced acute generalized exanthematous pustulosis confirmed by a positive patch-test resultJournal of the American Academy of Dermatology, 1997
- Dominance of the BV17 element in nickel‐specific human T cell receptors relates to severity of contact sensitivityEuropean Journal of Immunology, 1997
- Patch testing in severe cutaneous adverse drug reactions, including Stevens‐Johnson syndrome and toxic epidermal necrolysisContact Dermatitis, 1996
- Antigen‐presenting human T cells and antigen‐presenting B cells induce a similar cytokine profile in specific T cell clonesEuropean Journal of Immunology, 1993