Histopathologic Features in Vancomycin-Associated Drug-Induced Hypersensitivity Syndrome.

IF 1.6 4区 医学 Q3 DERMATOLOGY
Hannah B Haberecht, Rachel L Ziebart, Olivia C Iverson, Austin Todd, Mark D Davis, David A Wetter, Julio C Sartori-Valinotti, Hafsa M Cantwell, Marian T McEvoy, Nessa Aghazadeh Mohandesi, Afsaneh Alavi, Emma F Johnson
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引用次数: 0

Abstract

Background: Drug-induced hypersensitivity syndrome (DiHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), is a delayed and severe immune response to certain medications. We investigated vancomycin-induced DiHS/DRESS, notable for frequent and severe organ involvement, to describe its specific histopathology and the correlations between histopathologic and clinical findings.

Methods: A retrospective review was conducted to identify patients between 2006 and 2022 who received vancomycin, had archived skin biopsy specimens, and were scored as having probable or definite DiHS/DRESS. Clinical features were retrospectively collected, and biopsy specimens were reviewed by a board-certified dermatopathologist. A subset of histopathologic and clinical features was analyzed for statistical correlation.

Results: Twenty-three patients met the inclusion criteria. Most biopsy specimens (87%) showed an eczematous reaction pattern; 17 (74%) showed a secondary reaction pattern. Spongiosis (87%) and neutrophilic infiltration (91%) were common epidermal characteristics. The dermal inflammatory infiltrate was frequently superficial (87%) and consistently included plasma cells (96%). Eosinophils were present in the dermis in 70% of cases. Parakeratosis negatively correlated with liver involvement and positively correlated with desquamative rash. Epidermal lymphocytes were negatively correlated with the RegiSCAR score.

Conclusions: Vancomycin-associated DiHS/DRESS histopathology was characterized by a frequent eczematous reaction pattern, multiple coexisting reaction patterns, and epidermal neutrophilic infiltration.

万古霉素相关药物致过敏综合征的组织病理学特征。
背景:药物性超敏反应综合征(DiHS),或伴嗜酸性粒细胞增多和全身症状的药物反应(DRESS),是对某些药物的延迟和严重免疫反应。我们研究了万古霉素诱导的DiHS/DRESS,以频繁和严重的器官受累而显着,以描述其特定的组织病理学以及组织病理学和临床表现之间的相关性。方法:对2006年至2022年间接受万古霉素治疗、存档皮肤活检标本并被评分为可能或明确DiHS/DRESS的患者进行回顾性分析。回顾性收集临床特征,并由委员会认证的皮肤病理学家检查活检标本。组织病理学和临床特征的一个子集被分析为统计相关性。结果:23例患者符合纳入标准。大多数活检标本(87%)显示湿疹反应模式;17例(74%)出现二次反应模式。海绵状病变(87%)和中性粒细胞浸润(91%)是常见的表皮特征。真皮炎症浸润通常是浅表的(87%),并始终包括浆细胞(96%)。70%的病例真皮中存在嗜酸性粒细胞。角化不全与肝脏受累负相关,与脱屑性皮疹正相关。表皮淋巴细胞与RegiSCAR评分呈负相关。结论:万古霉素相关的DiHS/DRESS组织病理学特征为频繁的湿疹反应模式,多种反应模式共存,表皮嗜中性粒细胞浸润。
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来源期刊
CiteScore
3.20
自引率
5.90%
发文量
174
审稿时长
3-8 weeks
期刊介绍: Journal of Cutaneous Pathology publishes manuscripts broadly relevant to diseases of the skin and mucosae, with the aims of advancing scientific knowledge regarding dermatopathology and enhancing the communication between clinical practitioners and research scientists. Original scientific manuscripts on diagnostic and experimental cutaneous pathology are especially desirable. Timely, pertinent review articles also will be given high priority. Manuscripts based on light, fluorescence, and electron microscopy, histochemistry, immunology, molecular biology, and genetics, as well as allied sciences, are all welcome, provided their principal focus is on cutaneous pathology. Publication time will be kept as short as possible, ensuring that articles will be quickly available to all interested in this speciality.
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