Drug-Induced Lymphocyte Stimulation Test is not Useful for the Diagnosis of Drug-Induced Pneumonia

Abstract

Diagnosis of drug-induced pneumonia, which represents pulmonary toxicity caused by certain drugs, is difficult, as a large number of different drugs can elicit various immune-mediated diseases with distinct pathomechanisms. The drug-induced lymphocyte stimulation test (DLST) is widely used for diagnosing drug-induced pneumonia in Japan. Recent reports, however, indicate that DLST is not reliable for diagnosis of drug-induced pneumonia. To diagnose drug-induced pneumonia, a provocation test with the suspected drug is the most reliable method of assessing the relationship between the drug and pneumonia. We examined the correlation between the DLST and the provocation test in 6 cases of suspected drug-induced pneumonia. DLST was performed in all of the patients. The causes of pneumonia in all patients were confirmed by a provocation test. The DLST was positive in 3 of 6 cases of suspected drug-induced pneumonia, but the suspected drugs were ruled out by the provocation test. If we had relied solely on the DLST, these 3 cases would have been labeled as false allergy. The results of the DLST did not coincide with the results of the provocation test in any of the cases. Our results suggest that the DLST is not useful for the diagnosis of drug-induced pneumonia. Following provocation with the causative drug, reappearance of pulmonary infiltration was not observed in any of the cases. These findings indicate that a carefully performed provocation test is the safe and most reliable method.drug-induced lymphocyte stimulation test (DLST); drug-induced pneumonia; provocation test; challenge test; patch test

A Rare Cause of Acute Respiratory Failure and Elevated Eosinophils in Broncho-Alveolar Lavage Fluid

“…Asthma is an important differential diagnosis, but there is no evidence in the literature that chloroquine can provoke asthma symptoms [10,11] . Similar to our case, reports dealing with minocycline-induced eosinophilic pneumonitis showed that skin testing was unreliable to diagnose hypersensitivity [12,13] . Though these 2 reports stated that the lym-phocyte stimulation test did not facilitate the diagnosis of drug-related pulmonary hypersensitivity [12,13] , this test was positive in our case.…”

“…Similar to our case, reports dealing with minocycline-induced eosinophilic pneumonitis showed that skin testing was unreliable to diagnose hypersensitivity [12,13] . Though these 2 reports stated that the lym-phocyte stimulation test did not facilitate the diagnosis of drug-related pulmonary hypersensitivity [12,13] , this test was positive in our case. Therefore, a positive lymphocyte stimulation test confirms the existence of circulating drug-specific T cells which might play a role in the pathogenesis of eosinophilic pneumonitis [1] , but it does neither prove nor exclude the pulmonary hypersensitivity [13] .…”

“…Though these 2 reports stated that the lym-phocyte stimulation test did not facilitate the diagnosis of drug-related pulmonary hypersensitivity [12,13] , this test was positive in our case. Therefore, a positive lymphocyte stimulation test confirms the existence of circulating drug-specific T cells which might play a role in the pathogenesis of eosinophilic pneumonitis [1] , but it does neither prove nor exclude the pulmonary hypersensitivity [13] . Regarding acute eosinophilic pneumonia, newly onset smoking has been reported to be a possible trigger for this disease [1] .…”

Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches

“…Studies on the use of DLST in DIP are far from well controlled. Based on data that compared the results of the DLST and provocation tests for patients with DILD, DLST contributed little in detecting the causative agents in these patients [48,49]. …”

Pioglitazone-induced Pulmonary Injury in a Very Elderly Patient

“…Some drug-induced interstitial lung injury showed sequelae of fibrosis, consolidation, and organization (11,12). DLST has been used to evaluate the potential of drug-induced lung injury by each suspected drug (13). However, due to the considerable extent of false results, information obtained from a DLST is generally treated as not definitive, but as reference information.…”