loop-mediated isothermal amplification（LAMP）にてHLA-A＊3101を迅速検出したカルバマゼピンによるDIHSの2例

・本邦においてカルバマゼピン（Carbama-zepine：CBZ）による薬疹患者は，HLA-A＊3101の保有率がオッズ比約10倍で薬疹非発症群と比較して高いとのエビデンスが後ろ向き調査にて報告され，薬疹発症のマーカーとしての臨床応用が模索されている．

・HLAタイピングは保険適用外で，高価かつ結果返却まで1週間以上を要するため，早期診断・治療介入には有用とはいえない．

・CBZによる薬疹2症例に対して，既報告のLAMP（loop mediated isotheramal amplification）を用いたin houseでのHLA-A＊3101検出を行い1），早期の被疑薬同定，治療介入が行えた．

（「症例のポイント」より）

　

Two cases of rapid detection of HLA-A*3101 for the diagnosis of carbamazepine-induced adverse drug reaction

　

Niihara, Hiroyuki1）Kohno, Kunie1）Nakagawa, Yuhsei1）Shiratuki, Rie1）Tobita, Reiko1）Morita, Eishin1） 1）Department of Dermatology, Shimane University

　

A 63-year-old man with symptomatic epilepsy developed diffuse erythema on his trunk and extremities 2 months after being administered carbamazepine. He was referred to our department 14 days after the rash appeared. Loop-mediated isothermal amplification (LAMP)was performed for the detection of HLA-A＊3101. A positive result on LAMP confirmed the diagnosis within one hour. His symptoms disappeared on withdrawal of carbamazepine. Furthermore, an 80-year-old woman with trigeminal neuralgia developed diffuse erythema on her trunk and extremities 28 days after being administered carbamazepine. The causative drug was determined with a positive LAMP reaction for HLA-A＊3101. Her symptoms disappeared after methylprednisolone pulse therapy was administered. Overall, the LAMP assay for the detection of HLA-A＊3101 was useful for the diagnosis of carbamazepine-induced adverse drug reactions in these two cases.