Allergy Asthma Immunol Res.  2017 May;9(3):281-284. 10.4168/aair.2017.9.3.281.

A Case of Cycloserine-Induced Lichenoid Drug Eruption Supported by the Lymphocyte Transformation Test

• Kim J
• Park S
• Jung CM
• Oh CW
• Kwon JW

• KMID: 2371730
• DOI: http://doi.org/10.4168/aair.2017.9.3.281

Abstract

Lichenoid drug eruption (LDE) is a rare form of delayed-type drug eruption. Among anti-tuberculosis (Tb) agents, cycloserine (CS) has been reported as a rare cause of LDE. Positive results on the lymphocyte transformation test (LTT) have not been reported in patients with LDE. In the present case, we performed LTT and a patch test, and successfully proved CS as the offending drug in this patient, who had been treated with multiple anti-Tb drugs. These observations suggest that CS should be considered a possible cause of LDE and that LTT can be an option for the diagnosis of LDE.

Keyword

Cycloserine; lichenoid eruptions; lymphocyte activation; drug hypersensitivity; drug eruptions

MeSH Terms

Cycloserine
Diagnosis
Drug Eruptions*
Drug Hypersensitivity
Humans
Lichenoid Eruptions
Lymphocyte Activation*
Lymphocytes*
Patch Tests
Cycloserine

Figure

• 

  Fig. 1 Clinical features of LDE. (A) There was diffuse lichenoid eruption and widespread hyperkeratotic lesions with scales involving the trunk and extremities. (B) Three months after cessation of anti-tuberculosis medications. LDE, lichenoid drug eruption.

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  Fig. 2 Patch test with EMB (10%, 50%), CS (10%, 50%), and levofloxacin. Patch test showed weak positive results for EMB (10%, 50%) and strong positive results for CS (10%, 50%). EMB, ethambutol; CS, cycloserine.

• 

  Fig. 3 LTT using a CCK-8. (A) PBMCs stimulated with CS, EMB, and sham. Data are from triplicate assays and error bars indicate the standard error. (B) Cell proliferation (%) increased in a dose-dependent manner by CS stimulation. The numbers of cells were 1.70×106, 2.00×106, 2.22×106, and 2.02×106 for sham, cyclosporine 100 µg/mL, cyclosporine 500 µg/mL, and PHA as a positive control, respectively. Data are from triplicate assays and error bars indicate the standard deviation. *P=0.005 (Sham vs CS); **P=0.008 (Sham vs CS). LTT, lymphocyte transformation test; CCK-8, Cell Counting Kit-8; PBMCs, the proliferation of peripheral mononuclear cells; CS, cycloserine; EMB, ethambutol; PHA, phytohemagglutinin.

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