Lymphocyte stimulation test

Recently, lymphocyte stimulation tests were performed in order to evaluate the immunomodulatory properties of Astragalus saponins. Lymphocyte proliferation or transformation is a process whereby de novo DNA synthesis takes place in response to a mitogen or any other appreciable stimulator (concanavallin A). Astraversianins II, and X, astragalosides I, II, IV and VI and cyclocantosides E and G isolated from A. melanophrurius were able to stimulate mouse lymphocyte proliferation in the concentration range of 0.01-10 (ig/ml. At higher concentration, inhibition of thymidine incorporation was observed [72]. 

A 76-year-old man who had taken glibenclamide for 2 weeks, having switched from voglibose, developed pneumonitis a lymphocyte stimulation test was positive for glibenclamide (32). 

The positive lymphocyte stimulation test, the eosinophils, and the low blood concentrations 3 days after withdrawal suggest that hypersensitivity to troghtazone was the underlying cause. The authors reported that another patient with hepatitis after troghtazone had had a subacute course after withdrawal of the drug. 

A 62-year-old woman with normal hver function tests took troghtazone 400 mg/day in combination with gli-clazide 80 mg/day and pravastatin (125). After 9 months her transaminases were slightly above normal, but the HbAic was 7.0% and treatment was continued. Her hver enzymes were measured monthly and after 19 months rose abruptly. Troghtazone was withdrawn immediately and she received insulin. Her hver enzymes improved rapidly. A biopsy showed hepatic necrosis round the central vein and a mild inflammatory infiltrate and fibrosis in the portal area compatible with protracted acute hepatitis. A lymphocyte stimulation test and a skin test were negative for troghtazone. 

Lymphocyte stimulation test shows that the lymphocytes from patients with food allergy are more often stimulated by the food antigen than the lymphocytes of control subjects, although both sensitivity and specificity of the test have been low in most patients. 

In 10 patients with bucillamine-associated interstitial pneumonitis, the HLA antigen DR4 was present in all 10 and a positive lymphocyte stimulation test was found in three of the six patients tested (3). 

A 58-year-old woman developed acute renal insufficiency soon after a 7-day course of cefdinir 300 mg/day for acute bronchitis. Renal histology showed tubular atrophy and interstitial fibrosis accompanied by moderate lymphocyte infiltration. A lymphocyte stimulation test with cefdinir was positive. Serum creatinine concentrations continued to rise even after withdrawal of cefdinir, but steroid therapy normalized renal function. 

The results of a lymphocyte stimulation test suggested that disopyramide had been responsible. 

Based on a positive lymphocyte stimulation test, the authors were confident that this herbal remedy had caused pulmonary edema. 

Two Japanese patients developed pleural effusions while taking antituberculosis therapy and were believed to have isoniazid-induced lupus-like syndrome (44). This diagnosis was based on the presence of antinuclear antibody in the effusate, and in one patient, a positive lymphocyte stimulation test using isoniazid in the other patient it was negative. Both had moderately strongly positive serum antinuclear antibodies (1 160). In the first patient, the effusion disappeared 2 weeks after withdrawal of isoniazid in the other treatment was continued but the effusion nevertheless resolved in 10 weeks. 

A 29-year-old man developed an infiltrative maculo-papular eruption after 1 week of itraconazole 100 mg bd for tinea corporis (44). Itraconazole was withdrawn, and the lesions disappeared within 7 days. Scratch tests, patch tests, scratch-patch tests, and drug induced lymphocyte stimulation tests for itraconazole were negative however, rechallenge with systemic itraconazole induced a maculopapular eruption on the face, hands, and the dorsa of the feet. Empty itraconazole capsules had no cutaneous effects, suggesting an allergic reaction to a metabolite of the compound. 

An acute exanthematous pustular eruption has been reported in a 56-year-old man who had taken mexiletine 300 mg/day for 1 month (39). There was mUd hver dysfunction. Patch tests with mexiletine 10 and 20% were subsequently positive, but a lymphocyte stimulation test was negative. 

In addition to these cases, 37 cases of drug eruption due to mexiletine have been reported in Japan, with several common clinical features (37). The interval between initial drug therapy and the start of the eruption was relatively long (48-88 days) there was a high proportion of positive patch tests (86-97%) but a low incidence of positive lymphocyte stimulation tests (23-27%) there were frequent systemic symptoms, such as fever (93-94%) and liver dysfunction (43-78%) finally, some patients had multiple drug eruptions. 

A patient with agranulocytosis and a positive lymphocytic stimulation test recovered after withdrawal (1). 

A 38-year-old woman took norfloxacin (300 mg/day) and tiaramide hydrochloride (300 mg tds) for an infection with Mycoplasma pneumoniae. One day after the start of treatment, her symptoms of cough and fever worsened and she developed lumbago and hematuria. The diagnosis was confirmed by percutaneous renal biopsy. She slowly improved without specific treatment. Lymphocyte stimulation tests were negative, but rechallenge with norfloxacin was followed by bilateral lumbago. 

A 30-year-old Japanese man with polyarthritis, in whom sodium aurothiomalate for 3 years had been ineffective, was given penicillamine 200 mg/day (188). After 10 days he became febrile and 2 days later jaundiced. A lymphocyte stimulation test against penicillamine was positive, suggesting type IV hypersensitivity. Later on he had a good response to tiopronin, without further adverse reactions. 

Matsumura T, Yuhara T, Yamane K, Kono I, Kabashima T, Kashiwagi H. D-penicillamine-induced polymyositis occurring in patients with rheumatoid arthritis a report of two cases and demonstration of a positive lymphocyte stimulation test to D-penicillamine. Henry Ford Hosp Med J 1986 34(2) 123-6. 

A 62-year-old woman with severe asthma took oral pranlukast 450 mg/day and oral prednisolone 80 mg/day for a severe asthmatic attack. After oral prednisolone was tapered and subsequently withdrawn by day 35, she was maintained on pranlukast only and 5 days later had fever, deteriorating pulmonary symptoms, hypoxemia, and bibasal reticulonodular pulmonary infiltrates on chest CT. A transbronchial biopsy was consistent with drug-related interstitial pneumonitis. A lymphocyte stimulation test was positive for pranlukast. Her fever abated and her pulmonary symptoms markedly improved 3 days after withdrawal of pranlukast, and 5 months later the pulmonary infiltrates had completely resolved. 

An 86-year-old Japanese man received a pacemaker for atrioventricular block, and 2 months later developed a scaly erythema over the implantation site and later widespread nummular eczema. Histologically, the lesions showed slight spongiosis, intracellular edema, moderate acanthosis in the epidermis, and perivascular infiltration with thickened capillary walls in the dermis. The pacemaker contained titanium and a variety of other metals, but patch tests were all negative. However, titanium sensitivity was demonstrated by intracutaneous and lymphocyte stimulation tests. 

A 33-year-old man taking co-trimoxazole developed bilateral pulmonary infiltrates and a fever of 39 C after 2 weeks (25). Co-trimoxazole was withdrawn. The fever resolved 6 days later. A lung biopsy showed non-specific interstitial pneumonia. A lymphocyte stimulation test for co-trimoxazole was positive. 

Syrjala H, Herva E, Honen J, Saukkonen K, Salminen A. A whole-blood lymphocyte stimulation test for the diagnosis of human tularemia. J Infect Dis. 1984 150 912-915. 

Hepatic injury was reported in a 37-year-old man who had received a single intramuscular injection of 65 mg of a standardized horse chestnut extract prior to surgery. Liver tests performed 17 days after injection revealed moderate elevation of total bilirubin, ALP, GGTP and mild eosino-philia. The lymphocyte stimulation test was positive, and the liver biopsy demonstrated marked cholestasis with zonal necrosis in the centrilobular areas but showed little or no changes in the portal tracts (Takegoshi et al. 1986). 

Epp M (1962) Penicillin antibody in maternal and cord bloods and its possible relationship to hypersensitivity. Immunology 5 287 Erfmeyer JE (1981) Adverse reactions to penicillins Ann Allergy 47 288, 294 Evans DA (1967) The lymphocyte stimulation test in penidllin hypersensitivity. J Allergy Clin Immunol 39 340... 

Clinical observation is generally sufficient in orienting the diagnosis. It can be confirmed by cutaneous tests, the lymphocyte stimulation test (Federlin 1971 Hal-pern et al. 1971 Diem et al. 1982), or the inhibition of leukocytic migration and also by the determination of insulin-specific IgE using the RAST technique (Kumar 1977 Patterson et al. 1973). 

Toxic epidermal necrolysis has been attributed to intravenous ritodrine in a 26-year-old woman at 35 weeks of gestation a lymphocyte stimulation test with ritodrine hydrochloride was positive [57 ]. 

A 37-year-old Japanese man developed multiple pruritic emptions covering his entire body 3 months after multiple dental fillings. A lymphocyte stimulation test was positive to zinc chloride. A skin patch test with zinc chloride caused a severe widespread flare-up, as did removal of each of the zinc dental fillings one by one. 

Respiratoiy A 53-year-old man with chronic pulmonary aspergillosis developed near-fatal diffuse alveolar hemorrhage after receiving intravenous itraconazole a lymphocyte stimulation test was positive he did not respond to methylprednisolone but responded dramatically to hemoperfusion using a poly-m) in B-immobiUzed fiber column P6 ]. 

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