Drug reactions: granulysin in SJS/TEN: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Drug reactions: granulysin in SJS/TEN

Sample item

Widespread keratinocyte death occurs in Stevens-Johnson syndrome and toxic epidermal necrolysis. Which mediator released by cytotoxic T cells and NK cells is largely responsible?

AComplement fragment C3a from immune complexesBGranulysinCEosinophil major basic proteinDHistamine from IgE-bound mast cells

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Granulysin

SJS/TEN is a delayed type IV reaction in which drug-specific cytotoxic T cells and NK cells release granulysin, a cytolytic protein found in blister fluid at concentrations that correlate with severity. Other contributors include perforin, granzyme B and Fas ligand.

Option by option

A. Complement fragment C3a from immune complexes
C3a from immune complexes belongs to type III reactions such as serum sickness.
B. Granulysin (correct)
Correct. Granulysin released by cytotoxic cells drives the extensive keratinocyte apoptosis.
C. Eosinophil major basic protein
Eosinophil major basic protein contributes to eosinophilic injury, as in DRESS, rather than keratinocyte death in TEN.
D. Histamine from IgE-bound mast cells
Histamine from IgE-bound mast cells mediates type I urticaria and anaphylaxis, not epidermal necrolysis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is B, Granulysin. SJS/TEN is a delayed type IV reaction in which drug-specific cytotoxic T cells and NK cells release granulysin, a cytolytic protein found in blister fluid at concentrations that correlate with severity.

Why is "Complement fragment C3a from immune complexes" not the answer?

C3a from immune complexes belongs to type III reactions such as serum sickness.

Why is "Eosinophil major basic protein" not the answer?

Eosinophil major basic protein contributes to eosinophilic injury, as in DRESS, rather than keratinocyte death in TEN.

Why is "Histamine from IgE-bound mast cells" not the answer?

Histamine from IgE-bound mast cells mediates type I urticaria and anaphylaxis, not epidermal necrolysis.

What concept does this question test?

It tests Drug reactions: granulysin in SJS/TEN in Dermatology. Other contributors include perforin, granzyme B and Fas ligand.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Drug reactions: granulysin in SJS/TEN?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.