Acute generalized exanthematous pustulosis due to sulfamethoxazol with positive lymphocyte transformation test (LTT)

J Investig Allergol Clin Immunol. 2003;13(1):66-8.


We studied an acute generalized exanthematous pustulosis (AGEP) due to sulfamethoxazol in a 48-year-old woman with unusual findings in allergy testing. The histological picture provided evidence for a pustular drug eruption and leukocytoclastic vasculitis. Skin testing with sulfamethoxazol was negative for immediate-type reaction (scratch test) and delayed-type reaction (epicutaneous testing). A lymphocyte transformation test (LTT) showed a significant lymphocyte stimulation (stimulation index 5.04/2.61) toward sulfamethoxazol (200/100 mg/ml) by measuring the rate of built-in tritium-thymidine in the DNS of the patients lymphocytes, implicating a drug-specific hypersensibility of lymphocytes; we could be dealing with a combined type III and IV reaction by Coombs and Gell in this case. LTT may play a possible role in the determination of drug allergy in AGEP despite negative skin testing.

Publication types

  • Case Reports

MeSH terms

  • Administration, Topical
  • Anti-Infective Agents / adverse effects*
  • Anti-Inflammatory Agents / therapeutic use
  • Betamethasone / therapeutic use
  • Drug Eruptions / drug therapy
  • Drug Eruptions / etiology*
  • Exanthema / chemically induced*
  • Exanthema / drug therapy
  • Female
  • Glucocorticoids
  • Humans
  • Lymphocyte Activation
  • Middle Aged
  • Skin Tests
  • Sulfamethoxazole / adverse effects
  • Sulfamethoxazole / pharmacology
  • Trimethoprim / pharmacology
  • Trimethoprim, Sulfamethoxazole Drug Combination / adverse effects*
  • Vasculitis, Leukocytoclastic, Cutaneous / chemically induced*
  • Vasculitis, Leukocytoclastic, Cutaneous / drug therapy


  • Anti-Infective Agents
  • Anti-Inflammatory Agents
  • Glucocorticoids
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Betamethasone
  • Trimethoprim
  • Sulfamethoxazole