In vitro interferon-gamma release test in patients with drug-induced pemphigus.

BACKGROUND Drug-specific CD8+ TH1 lymphocytes have been found in the peripheral blood and involved skin of patients with drug-induced bullous exanthems. OBJECTIVES To determine whether the interferon-gamma release test can identify culprit drugs in pemphigus patients. METHODS Clinical and laboratory workup for pemphigus was performed in 14 pemphigus vulgaris patients who had been exposed to drugs, and the IFN-gamma release test was conducted on their lymphocytes from heparinized venous blood cultured with medium, phytohemagglutinin and one of 32 drugs, or medium and phytohemagglutinin alone. RESULTS Ten of the patients and 13 of the 32 drugs exhibited a positive response to the test. Eight of the 10 patients with positive IFN-gamma test results had a less severe course of the disease, with fast reduction in steroid dosage. CONCLUSIONS The findings demonstrate both the ability of the IFN-gamma release test to identify drugs that can induce pemphigus, and its usefulness in the diagnostic workup of pemphigus patients.