Rapid immunochromatographic test for serum granulysin is useful for the prediction of Stevens-Johnson syndrome and toxic epidermal necrolysis

J Am Acad Dermatol. 2011 Jul;65(1):65-8. doi: 10.1016/j.jaad.2010.04.042. Epub 2011 Apr 19.

Abstract

Background: Life-threatening adverse drug reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) sometimes start with clinical features of ordinary drug-induced skin reactions (ODSRs) and it may be difficult to make a correct diagnosis before severe mucocutaneous erosions occur. We have reported that serum granulysin levels are elevated (cut off: 10 ng/mL) in patients with SJS/TEN before generalized blisters form.

Objective: We sought to develop a rapid detection system for elevated serum granulysin to predict the progression from ODSRs.

Methods: Serum samples from 5 patients with SJS/TEN at 2 to 4 days before mucocutaneous erosions formed were analyzed. Sera from 24 patients with ODSRs and 31 healthy volunteers were also investigated as control subjects. We developed a rapid immunochromatographic assay for the detection of high levels of serum granulysin using two different antigranulysin monoclonal antibodies.

Results: The immunochromatographic test showed positive results for 4 of 5 patients with SJS/TEN but only one patient of 24 with ODSRs. The results correlated closely with those of enzyme-linked immunosorbent assays.

Limitations: The validation of the long-time stability in this test strip has not been investigated.

Conclusion: This novel test enables the prediction of SJS/TEN occurrence in patients even when only features of ODSRs are noted clinically.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antigens, Differentiation, T-Lymphocyte / blood*
  • Biomarkers / blood
  • Chromatography / methods
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Immunoassay / instrumentation
  • Immunoassay / methods*
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Risk Assessment
  • Sampling Studies
  • Stevens-Johnson Syndrome / blood*
  • Stevens-Johnson Syndrome / diagnosis*
  • Stevens-Johnson Syndrome / epidemiology
  • Stevens-Johnson Syndrome / etiology

Substances

  • Antigens, Differentiation, T-Lymphocyte
  • Biomarkers
  • GNLY protein, human