Drug reaction with eosinophilia and systemic symptoms (DRESS): A histopathology based analysis.
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Date
2016-01
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Abstract
Background: The data on the histology of cutaneous lesions of drug reaction with eosinophilia
and systemic symptoms (DRESS) is limited. Aims: To study the histopathology of cutaneous
lesions of drug reaction with eosinophilia and systemic symptoms (DRESS) and to identify
any features with diagnostic or prognostic signifi cance. Methods: All patients admitted to
the dermatology ward of government medical college, Kozhikode from January 1, 2014 to
December 31, 2014 with probable or defi nite DRESS as per the RegiSCAR scoring system and
who were willing to undergo skin biopsy were included in this prospective study. Results: The
study population comprised of nine patients. The consistent histological fi nding documented
was the predominantly lymphocytic dermal infl ammatory infi ltrate. Four of the fi ve patients
whose histology revealed focal interface dermatitis and keratinocyte vacuolation with or
without apoptotic keratinocytes, had elevated liver transaminases. Tissue eosinophilia was
associated with disease fl ares. The presence of atypical lymphocytes in peripheral smear
and histological evidence of dense dermal infl ammatory infi ltrate showed an association with
hepatic involvement. Limitations: The main limitations of our study were the small sample size
and our inability to carry out a detailed immunohistochemistry work-up. Conclusions: In the
appropriate setting, varying combinations of epidermal hyperplasia, spongiosis, parakeratosis
and individually necrotic keratinocytes in the background of lymphocyte predominant dermal
infi ltrate (with some atypia) favor a diagnosis of drug reaction with eosinophilia and systemic
symptoms. Female sex, the presence of atypical lymphocytes in peripheral smear, dense
dermal infl ammatory infi ltrate, tissue eosinophilia and interface dermatitis with or without
keratinocyte necrosis was associated with a poor prognosis.
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Keywords
Drug reaction with eosinophilia and systemic symptoms, histology, interface dermatitis
Citation
Sasidharanpillai Sarita, Govindan Aparna, Riyaz Najeeba, Binitha Manikoth P, Muhammed Kunnummal, Khader Anza, Mariyath Olasseri K Reena, Simin Muhammedkutty, Subin Kunnari. Drug reaction with eosinophilia and systemic symptoms (DRESS): A histopathology based analysis. Indian Journal of Dermatology, Venereology and Leprology. 2016 Jan-Feb; 82(1): 28-36.