|
Drug hypersensitivity mimicking mycosis fungoides induced by consecutive use of carbamazepine and topiramate Xiao-Ning Zhang1,2, Yang Luo1, Jun Liu3, Shu-Zhen Qi1, Xu Yao1* 1Department of Allergy and Rheumatology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu 210042, China. 2Department of Dermatology, Chinese PLA General Hospital, Beijing 100853, China. 3Department of Dermatology, the Affiliated Drum Tower Hospital of Nanjing University, Nanjing, Jiangsu 210008, China. *Corresponding author: Dr. Xu Yao, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu 210042, China.Email: dryao_xu@126.com. Conflicts of interest: There are no conflicts of interest. doi: 10.3760/cma.j.issn.2096-5540.2018.01.002 Int J Dermatol Venereol, 2018,1(1):2-7 [Abstract] Objective To make diagnosis of patient with topiramate-induced hypersensitivity presenting with generalized lesions that mimicked mycosis fungoides clinically and histologically. Methods Drug-specific T cell activation testing, ELIspot assay, and HLA-B*1502 assay were used to identify the disease. Results The patient was initially treated with carbamazepine for 3 weeks, and withdrawal of carbamazepine led to regression of the lesions; however, substitution of topiramate resulted in the reappearance and progressive worsening of infiltrated erythematous plaques several weeks later. Topiramate was subsequently stopped, and the lesions had resolved without relapse during 1-year follow-up. Immunochemical analysis of the lesion showed that most of the atypical lymphocytes were CD3, CD5, CD4, and Ki-67 (40%－50%) positive but CD8, CD30, CD56, TIA-1, and GrB negative. Drug-specific T lymphocyte activation testing and an enzyme-linked immunospot assay were conducted to quantify drug-reactive T cells and cytokine-releasing cells in peripheral blood mononuclear cell specimens to substantiate the diagnosis of drug eruptions. Conclusion To our knowledge, our report presents the first case of topiramate-induced mycosis fungoides-like lesions based on the clinical and histological evidences. [Keywords] Drug eruptions; Mycosis fungoides; Carbamazepine; Lymphocyte activation; Topiramate
|
|
|
