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Clinical Epidemiology and Ageing

Histopathology of drug rash with eosinophilia and systemic symptoms syndrome: a morphological and phenotypical study.

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 Br J Dermatol. 2015;173(1):50-8.

BACKGROUND: The histopathological features of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome remain poorly characterized.

OBJECTIVES: 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).

METHODS: We conducted a retrospective study on 50 skin biopsies from patients with DRESS syndrome (n = 36). Histopathological and immunophenotypical features were studied and compared with a series of MPRs (n = 20).

RESULTS: 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 (P < 0.01), and appeared to be more marked in DRESS syndrome with severe cutaneous lesions (P = 0.01) than in less severe cases of DRESS and MPR. A higher proportion of CD8(+) and granzyme B(+) 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%).

CONCLUSIONS: The histopathology of DRESS syndrome highlights various associated inflammatory patterns in a single biopsy. Cutaneous effector lymphocytes comprise a high proportion of polyclonal CD8(+) granzyme B(+) T lymphocytes.

MeSH terms: Adolescent; Adult; Aged; Aged, 80 and over; Allopurinol; Anti-Bacterial Agents; B-Lymphocytes; Carbamazepine; Drug Hypersensitivity Syndrome; Exanthema; Female; Gout Suppressants; Humans; Immunohistochemistry; Male; Middle Aged; Minocycline; Phenotype; Retrospective Studies; Sulfasalazine; T-Lymphocytes; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult
DOI: 10.1111/bjd.13683

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