Histopathology of drug rash with eosinophilia and systemic symptoms syndrome: a morphological and phenotypical study. (16th April 2015)

• Record Type: Journal Article
• Authors: Ortonne, N.; Valeyrie‐Allanore, L.; Bastuji‐Garin, S.; Wechsler, J.; de Feraudy, S.; Duong, T.‐A.; Delfau‐Larue, M.‐H.; Chosidow, O.; Wolkenstein, P.; Roujeau, J.‐C.
• Is Part Of: British journal of dermatology. Volume 173:Number 1(2015:Jul.)
• Page Start: 50
• Page End: 58
• Publication Date: 2015-04-16
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.13683
• Languages: English
• ISSNs: 0007-0963

Abstract

<abstract abstract-type="main" id="bjd13683-abs-0001"> <title>Summary</title> <sec id="bjd13683-sec-0001" sec-type="section"> <title>Background</title> <p>The histopathological features of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome remain poorly characterized.</p> </sec> <sec id="bjd13683-sec-0002" sec-type="section"> <title>Objectives</title> <p>To better characterize the histopathological features of DRESS syndrome, and define the phenotype of the effector cells in the skin and compare it with maculopapular rash (MPR).</p> </sec> <sec id="bjd13683-sec-0003" sec-type="section"> <title>Methods</title> <p>We conducted a retrospective study on 50 skin biopsies from patients with DRESS syndrome (<italic>n </italic>=<italic> </italic>36). Histopathological and immunophenotypical features were studied and compared with a series of MPRs (<italic>n </italic>=<italic> </italic>20).</p> </sec> <sec id="bjd13683-sec-0004" sec-type="section"> <title>Results</title> <p>Foci of interface dermatitis, involving cutaneous adnexae, were frequently seen in cases of DRESS. Eosinophils were seen in only 20% of cases and neutrophils in 42%. Eczematous (40%), interface dermatitis (74%), acute generalized exanthematic pustulosis‐like (20%) and erythema multiforme‐like (24%) patterns were observed. The association of two or three of these patterns in a single biopsy was significantly more frequent in cases of DRESS than in a series of nondrug‐induced dermatoses (<italic>P</italic> < 0·01), and appeared to be more marked in DRESS syndrome with severe cutaneous lesions (<italic>P</italic> = 0·01) than in less severe cases of DRESS and MPR. A higher proportion of CD8<sup>+</sup> and granzyme B<sup>+</sup> lymphocytes was observed in cases of DRESS with severe cutaneous eruptions (erythroderma and/or bullae). Atypical lymphocytes were found in 28% of biopsies, and expressed CD8 in most cases; a cutaneous T‐cell clone was rarely found (6%).</p> </sec> <sec id="bjd13683-sec-0005" sec-type="section"> <title>Conclusions</title> <p>The histopathology of DRESS syndrome highlights various associated inflammatory patterns in a single biopsy. Cutaneous effector lymphocytes comprise a high proportion of polyclonal CD8<sup>+</sup> granzyme B<sup>+</sup> T lymphocytes.</p> </sec> </abstract>