key: cord-0864359-wrmhmqkq
authors: Hayakawa, Jun; Takakura, Hiroki; Mizukawa, Yoshiko; Shiohara, Tetsuo
title: COVID‐19‐related cutaneous manifestations associated with multiple drug sensitization as shown by lymphocyte transformation test
date: 2020-08-18
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16878
sha: e3309687bf2bc00ece1c5afdefa53a9ada8c62b7
doc_id: 864359
cord_uid: wrmhmqkq

Patients with novel coronavirus disease 2019 (COVID‐19) can present with a wide variety of cutaneous manifestations. Drug‐induced eruptions, however, are often indistinguishable from the COVID‐19‐related rash

Patients with novel coronavirus disease 2019 (COVID-19) can present with a wide variety of cutaneous manifestations (1, 2) . Drug-induced eruptions, however, are often indistinguishable from the COVID-19-related rash. Because many patients (~20%) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been shown to develop cutaneous manifestations (3), the rash may have been reported as COVID-19-related rash without excluding the possibility of drug eruptions. Here, we report a case suspected of COVID-19-related rash, in which lymphocyte transformation tests (LTTs) to the culprit drugs were positive.

A 44-year-old man presented with fever (38.5˚C).

He denied cough, sore throat or The main difficulty in assigning a pathogenic role to SARS-CoV-2 infection in any cutaneous manifestation is that there were no or few standard laboratory methods to distinguish between virally-induced rash and drug-induced rash. The identification of the causative drug appears to rely on the time interval between the beginning of drug use and onset of rash (4). In our patient, loxoprofen was the most likely causative drug for cutaneous manifestations. In view of our observation that positive LTT reactions were detected not only to loxoprofen but also to other two drugs (Stimulation Index to each drug, 2.03-2.10), it is likely that our patient was sensitized to all the drugs. Such "multiple drug hypersensitivity" can be most efficiently proven by LTTs (5) .

Interestingly, such "multiple drug hypersensitivity" was often observed associated with mycoplasma pneumoniae infection (6) . No previous reports, however, described the occurrence

This article is protected by copyright. All rights reserved of multiple drug hypersensitivity in patients with SARS-CoV-2 infection. A straightforward interpretation is that our patient could be immunologically sensitized to multiple medications probably due to preceding or underlying SARS-CoV-2 infection, although it remains unknown whether SARS-CoV-2 infection could serve to enhance the activation of drug-specific T cells with cross-reactive reactivity (7) . Nevertheless, we cannot totally exclude the possibility that multiple drug sensitization proven solely by LTTs may be a mere epiphenomenon of the underlying SARS-CoV-2 infection.

In conclusion, we recommend that LTT tests be utilized in any patient with cutaneous 

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Stevens-Johnson syndrome and toxic epidermal necrolysis: Assessment of medication risks with emphasis on recently marketed drugs. The Euro SCSR-study

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A distinctive skin rash associated

The patient in this manuscript has given written informed consent to publication of his case details.

This article is protected by copyright. All rights reserved