The role of macrophage migration inhibition factor in toxic epidermal necrolysis

Sima Halevy, Ella Livni

    Research output: Contribution to journalArticlepeer-review

    6 Scopus citations

    Abstract

    Patient A: A 60-year-old man developed toxic epidermal necrolysis (TEN) following several weeks of treatment with two kinds of drug; co-trimoxazole and acetazolamide. On the basis of time relationship data, both drugs could be considered as the inducers of the cutaneous reaction. Guide tables indicated that co-trimoxazole is one of the most common inducers of TEN, whereas acetazolamide has been reported as a possible uncommon inducer of TEN. Drug intake was stopped, and treatment with prednisone (120 mg/day) was instituted, followed by a gradual tapering of the dosage. A month later, complete remission of the skin lesions was observed. A macrophage migration inhibition factor (MIF) test was performed towards the drugs taken, in an attempt to identify the offending drug. The macrophage migration inhibition factor (MIF) test was positive towards co-trimoxazole and negative for acetazolamide. Positive MIF responses towards co-trimoxazole were not recorded in ten control patients (control I) treated with the drug with no manifestations of drug eruption. Patient B: TEN was diagnosed in an 84-year- old man treated prior to the appearance of the eruption with two kinds of drug: furosemide, which had been taken for several weeks, and nitrofurantoin, which had been taken for 3 months, on the basis of time relationship data, furosemide was suspected to be the offending drug; however, guide tables indicated nitrofurantoin as a possible inducer of TEN, whereas the role of furosemide (a sulfa drug) as an inducer of TEN has not yet been reported. Drug intake was stopped, and following supportive treatment, without the addition of corticosteroids, the skin lesions disappeared 3 weeks later. A MIF test was performed towards furosemide and nitrofurantoin. The MIF test was positive towards furosemide and negative for nitrofurantoin. Positive MIF responses towards furosemide were not recorded in seven control patients (control II) treated with the drug with no manifestations of drug eruption. The MIF test technique: The MIF test was performed according to the modified method of Livni et al. A migration index of 0.80 or less at one or more of the drug concentrations was considered to be a positive MIF test. Statistical analysis: Statistical analysis of MIF test results in TEN patients and controls was performed using Fisher's exact test (F.E.T.). The occurrence of positive MIF responses towards drugs recorded in TEN patients (2/4) was significantly higher (P<0.05) than that recorded in the controls (0/17). The MIF test results in TEN patients and controls are summarized in Table 1.

    Original languageEnglish
    Pages (from-to)776-778
    Number of pages3
    JournalInternational Journal of Dermatology
    Volume36
    Issue number10
    StatePublished - 1 Oct 1997

    ASJC Scopus subject areas

    • Dermatology

    Fingerprint

    Dive into the research topics of 'The role of macrophage migration inhibition factor in toxic epidermal necrolysis'. Together they form a unique fingerprint.

    Cite this