Miyauchi H, Hosokawa H, Akaeda T, Iba H, Asada Y
Department of Dermatology, Kansai Medical University, Osaka, Japan.
Arch Dermatol. 1991 Jun;127(6):851-5.
A patient with bromisovalum-induced toxic epidermal necrolysis showed pronounced delayed hypersensitivity to bromisovalum by patch testing. Biopsy specimens from the cutaneous lesion and the site of the positive patch test reaction were analyzed and compared immunohistologically. The findings were similar: most of the mononuclear cells disposed along the dermoepidermal junction and migrating into the epidermis were CD8-positive lymphocytes, whereas the dermal inflammatory infiltrates were composed predominantly of CD4-positive lymphocytes. This case showed the potential usefulness of patch testing in evaluating cases of toxic epidermal necrolysis. We believe that delayed hypersensitivity plays a crucial role in the development of drug-induced toxic epidermal necrolysis. Furthermore, potential effector cells with phenotypic characteristics of CD8-positive lymphocytes (suppressor/cytotoxic T cells) seem to represent important mediators of the epidermal damage of the cutaneous lesion in our case.
一名因溴米那普鲁卡因引起中毒性表皮坏死松解症的患者，通过斑贴试验显示对溴米那普鲁卡因有明显的迟发型超敏反应。对皮肤病变部位和斑贴试验阳性反应部位的活检标本进行免疫组织学分析和比较。结果相似：沿真皮表皮交界处分布并迁移至表皮的大多数单核细胞为CD8阳性淋巴细胞，而真皮炎症浸润主要由CD4阳性淋巴细胞组成。该病例显示了斑贴试验在评估中毒性表皮坏死松解症病例中的潜在用途。我们认为迟发型超敏反应在药物性中毒性表皮坏死松解症的发生中起关键作用。此外，具有CD8阳性淋巴细胞（抑制/细胞毒性T细胞）表型特征的潜在效应细胞似乎是我们病例中皮肤病变表皮损伤的重要介质。
