Histopathological analysis and clinical correlation of drug reaction with eosinophilia and systemic symptoms (DRESS). (1st April 2014)

• Record Type: Journal Article
• Authors: Chi, M.‐H.; Hui, R.C.‐Y.; Yang, C.‐H.; Lin, J.‐Y.; Lin, Y.‐T.; Ho, H.‐C.; Chung, W.‐H.; Kuo, T.‐T.
• Is Part Of: British journal of dermatology. Volume 170:Number 4(2014:Apr.)
• Page Start: 866
• Page End: 873
• Publication Date: 2014-04-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.12783
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe cutaneous adverse drug reaction. However, its histopathological features have not been well defined. Objectives: To identify the clinicohistopathological findings of DRESS, and analyse the cutaneous histopathological changes observed in DRESS compared with those observed in maculopapular exanthema (MPE). Methods: In a retrospective study, conducted at Chang Gung Memorial Hospital (Taiwan) between 2001 and 2011, we compared the clinicohistopathological features of 32 patients with probable/definite DRESS (defined by the RegiSCAR scoring system) with those of 17 patients with MPE. Results: The major pathological changes observed in patients with DRESS included dyskeratosis (97%), epidermal spongiosis (78%), interface vacuolization (91%), perivascular lymphocytic infiltration (97%) and eosinophilic infiltration (72%). Many pathological features were common to both MPE and DRESS. However, severe dyskeratosis, epidermal spongiosis and severe interface vacuolization were significantly more prominent in cases of DRESS ( P < 0·05). The presence of severe dyskeratosis was significantly associated with the clinical severity of renal impairment ( P = 0·01). Conclusions: The severe dyskeratosis detected in patients with DRESS may correlate with a greater extent of systemic involvement compared with that noted in MPE. However, the histopathological changes associated with DRESS are not entirely specific.