HLA-A*24:02/B*51:01 haplotype and lamotrigine-induced cutaneous adverse drug reactions in Koreans

Antiepileptic drugs (AEDs) have been known to induce cutaneous adverse drug reaction (cADR), ranging from a mild maculopapular eruption (MPE) to potentially life-threatening cADRs such as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Despite studies examining mechanisms associated with human leukocyte antigen (HLA), the association between lamotrigine (LTG)-induced cADR and HLA alleles still has room to investigate. We investigated HLA-A,-B, and -C alleles in LTG-induced cADR. The medical records of four patients with LTG-induced cADR were retrospectively reviewed. All patients were treated with LTG for epilepsy. All recovered from cADR after stopping LTG treatment and receiving intensive care. HLA-A, -B, and -C genotyping was performed in all four patients using a PCR-sequence-based typing (SBT) method. Two patients had SJS, and the other two had MPE due to LTG. The range of latency to cADR after the initial LTG dose was 19–42 days. Two patients experienced cross-reactivity with other aromatic or new AEDs. Expression of the HLA-A*24:02/B*51:01 haplotype was detected in three (75%) patients with LTG-induced cADR. The other patient carried homozygous HLA-B*58:01 alleles. The results suggest that Korean individuals with the HLA-A*24:02/B*51:01 haplotype may be susceptible to LTG-induced cADR. Further investigations are necessary to confirm these findings.

A Case of Peripheral T-cell Lymphoma Showing Generalized Maculopapular Eruption / 대한피부과학회지

In revised WHO classification, "peripheral T-cell lymphoma, unspecified" includes pleomorphic small/medium-sized T cell lymphoma, pleomorphic type and immunoblastic type of CD30+ large cell lymphoma, CD30+ large cell lymphoma by EORTC classification. The skin manifestations of "peripheral T-cell lymphoma, unspecified" can be various, for example, papules, plaques, nodules and erythroderma etc. Of them, generalized maculopapular eruption is known to be rare. A 52-year?old woman presented with widespread erythematous maculopapules on the trunk and extremities. On skin biopsy, there was small to medium-sized lymphocytic infiltration in entire dermis and subcutis. In immunohistochemical staining, the infiltrating cells were: CD3+, CD4+, CD5+, CD45RO+, CD8+, CD30, CD56. Clonal T cell receptor gene rearrangement was present.