Clopidogrel-induced acute generalized exanthematous pustulosis with elevated Thl7 cytokine levels as determined by a drug lymphocyte stimulation test

摘要

Madam, We present the first case of acute generalized exanthematous pustulosis (AGEP) with a positive drug lymphocyte stimulation test (DLST) for clopidogrel and elevated interleukin (IL)-l 7A and IL-17F in the culture supernatant, which suggests that Thl7 may be involved in the pathogenesis of AGEP.Treatment with clopidogrel was initiated in a 7 5-year-old man after insertion of a stent following myocardial infarction. Seven days later, he developed extending erythema with numerous small, nonfollicular pustules on the forearms (Fig. la), trunk and face which was accompanied by a fever (38'1 degC). Laboratory investigations showed marked leucocy-tosis (12-9 X 109 L"1) with a neutrophil count of 10-9 X 109 IT1 and an eosinophil count of 0-13 X 109 IT1. The C-reactive protein level was elevated at 66 mg L and the estimated glomerular filtration rate was decreased at 46 mL min"1 per 1-73 m2, yet liver function tests were normal. The patient had a medical history of psoriasis vulgaris, which had been well controlled with a potent topical steroid. Skin biopsy from the right forearm demonstrated the presence of a subcorneal infiltrate of neutrophils, spongiosis, and oedema of the papillary dermis with an infiltrate of lymphocytes and eosinophils. Psoriatic changes such as acanthosis and parakeratosis were absent (Fig. lb).