Internal Medicine

P1: RLJ/OZN P2: KUF

0521779407-D-01 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:41

508 Drug Eruptions Dubin-Johnson Syndrome

■Patch testing 1–2% in PET for erythroderma, eczematous, pustular,

blistering, and fixed drug eruptions (over area of fixed eruption)

■In vitro testing (lymphocyte transformation and lymphocyte toxicity

test)

Advice to Patient & Family

■Which drug(s) was the most likely cause, potentially cross-reacting

drugs, what drugs are safe, increased risk to first-degree relatives in

hypersensitivity syndrome

Report

■Report potentially severe or unusual reactions to regulatory author-

ities/drug manufacturer.

follow-up

n/a

complications and prognosis

n/a

Dubin-Johnson Syndrome..............................

WILLIAM E. BERQUIST, MD

history & physical

■incidence: uncommon

■inheritance: autosomal recessive

■occasional mild jaundice, normal exam

■increased bilirubin noted with estrogens, oral contraceptive use,

trauma, pregnancy or surgery

tests

Basic Tests

■total bilirubin varies from 1–25 mg/dl and about 60% conjugated

■normal liver enzymes

Specific Diagnostic

■BSP clearance slow (>20% retention at 45 min); late rise at 1.5–2 hours

■urine corproporphyrin pattern: reversed ratio of coproporphyrin III

to coproporphyrin I from 3:1 (normal) to 1:4

■normal total urinary corproporphyrins

■liver biopsy histology: melanin-like hepatocyte pigmentation