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Inicio Allergologia et Immunopathologia Serum soluble Fas ligand levels and peripheral blood lymphocyte subsets in patie...
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Vol. 48. Issue 4.
Pages 339-347 (July - August 2020)
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Vol. 48. Issue 4.
Pages 339-347 (July - August 2020)
Original Article
DOI: 10.1016/j.aller.2019.02.003
Serum soluble Fas ligand levels and peripheral blood lymphocyte subsets in patients with drug-induced maculopapular rashes, dress, and viral exanthemas
M. Yazicioglua,
Corresponding author

Corresponding author.
, P. Gokmirza Ozdemira, B. Turgutb, N. Sutc
a Department of Pediatric Allergy and Clinical Immunology, Trakya University, School of Medicine, Edirne, Turkey
b Department of Internal Medicine, Trakya University, School of Medicine, Edirne, Turkey
c Department of Biostatistics, Trakya University, School of Medicine, Edirne, Turkey
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Tables (3)
Table 1. Clinical data of the patients with viral serology and drug allergy workup.
Table 2. Descriptive data on FBC with white blood cell differential on admission (T1) in all groups and during the following period (T2–T3) in groups I–III.
Table 3. Peripheral blood lymphocyte subtypes, CD4+/CD8+ ratio, and serum soluble FasL levels in initial (T1), second (T2), and final samples (T3).
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Fatty acid synthetase (Fas)/Fas ligand (FasL)-dependent apoptotic pathways have been reported as being involved in the pathogenesis of drug-induced maculopapular rashes.


We investigated serum soluble FasL (sFasL) levels and peripheral blood lymphocyte subtypes to discriminate maculopapular drug eruptions (MPDE) from viral exanthema (VE).


Children with confirmed MPDE (group I), VE (group II), and drug rashes with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS) (group III) were included. Serum sFasL levels and peripheral blood lymphocyte subtypes were analyzed in groups I–III on admission, and repeated twice (only once for group IV – controls).


There were no significant serum soluble FasL level differences among the groups for all the samples. In the initial samples, CD19+ cell numbers in group II were significantly higher than in group IV, and the CD4+/CD8+ ratio was higher than groups I and IV. In the second samples, CD4+ and CD19+ cell numbers were significantly higher in group II than group I. In the final samples, CD4+ cell numbers in group II were significantly higher than group I and group III. CD19+ cells numbers in group III were significantly lower than the other groups for all samples.


Serum sFasL levels were not found to be useful in discriminating viral exanthemas from other drug rashes. The significant differences between MPDE, VE, and DRESS were high CD4+ and CD19+ cell-count numbers in VE but low B-cell numbers in DRESS. This might be important for discriminating VE from DRESS, and the low B-cell count in early symptoms might be a useful predictor of DRESS development.

Drug-induced maculopapular rashes
Viral exanthemas
Soluble Fas ligand
Lymphocyte subpopulations


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