Negative Response of Lymphocyte Transformation Test (LTT) in a Patient Diagnosed as Stevens-Johnson Syndrome: ACase Report
ABSTRACT: Evidences for the
key role of T-lymphocytes in the pathophysiology of Stevens-Johnson syndrome
(SJS) may be evaluated by drug patch test (DPT) and lymphocyte transformation
test (LTT). Purpose: This LTT technology may reveal the role and function of
T-lymphocytes for both diagnostic and research purposes. Case: A 33 year-old
woman was admited in Dermatology and Venereology Ward at Dr. Soetomo General
Hospital with skin and mucous membrane lesions after taking oral medication.
Clinical and laboratory examination were performed, establishing the diagnosis
of SJS caused by suspect amoxycillin and paracetamol. Case management: The
suspected drug was discontinued immediately. Patient was given appropriate
supportive treatment, systemic antibiotic, and intravenous dexamethasone with
initial adjusted dose of 0.1-0.2 mg/kg/day daily according to clinical
improvement. The DPT and LTT were performed 6 months after the lesions healed completely.
Both DPT and LTT revealed negative results. LTT is based on the principle that
T-cells proliferate in the presence of a specific-antigen, with sensitivity and
specificity of 60-70% and 85%, respectively. The LTT revealed negative
response, stimulation index (SI<2). Patients with SJS often show weak
positive or even negative LTT response. Conclusions: Negativeresult of DPT in
SJS does not exclude suspected drug. LTT is more objective and specific than
DPT, however the clinical severity is not associated with high SI values.
Key words: Stevens-Johnson
syndrome (SJS), drug patch test (DPT), lymphocyte transformation test (LTT)
Penulis: Ryski Meilia
Novarina, Trisniartami Setyaningrum
Kode Jurnal: jpkedokterandd150744