Abstract
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterized by an heterogeneous group of severe dermatologic manifestations and systemic involvement, due to several groups of medicaments. A series of 9 consecutive cases, observed from 2008 to 2013 in the Department of Dermatology, University of Pavia, is reported, all satisfying the clinical, hematological and systemic diagnostic criteria of DRESS. Clinically, 4 out of 9 patients had an urticarial and papular eruption, 2 an erythema-multiforme-like (EM-like) pattern, 2 erythroderma and 1 had an erythematous and macular reaction. Aim of the study was to describe the histopathologic features of DRESS and to trace a possible correlation between the four clinical recognized types of the syndrome and the histopathological patterns. Predominantly, a superficial perivascular lymphocytic infiltrate, extravasation of erythrocytes, and focal interface changes characterized DRESS cases. Less frequently, histopathology revealed the presence of necrotic keratinocytes; surprisingly, only in 2 cases the presence of rare dermal eosinophils was detected, even if all the patients had significant peripheral eosinophilia. A histopathological diagnosis of DRESS seems per se, according to our data, not feasible, since the main histopathological changes (interface changes, superficial perivascular dermatitis, focal spongiosis, lichenoid infiltrate, rare presence of necrotic keratinocytes) can be interpreted generically as a drug induced dermatitis. The above mentioned histopathological changes, however, when associated with clinical information on cutaneous and systemic involvement of the patient, allow the pathologist or the dermatopathologist to make a diagnosis of DRESS with a reliable margin of certainty.
| Original language | English |
|---|---|
| Pages (from-to) | 291-300 |
| Number of pages | 10 |
| Journal | Giornale Italiano di Dermatologia e Venereologia |
| Volume | 149 |
| Issue number | 3 |
| Publication status | Published - 2014 |
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Keywords
- Diagnosis
- Drug hypersensitivity syndrome
- Drug-related side effects and adverse reactions
ASJC Scopus subject areas
- Dermatology
Cite this
Histopathologic spectrum of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) : A diagnosis that needs clinico-pathological correlation. / Borroni, G.; Torti, S.; Pezzini, C.; Vassallo, C.; Rosso, R.; D'Ospina, R. M.; Tomasini, C.; Brazzelli, V.
In: Giornale Italiano di Dermatologia e Venereologia, Vol. 149, No. 3, 2014, p. 291-300.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Histopathologic spectrum of Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
T2 - A diagnosis that needs clinico-pathological correlation
AU - Borroni, G.
AU - Torti, S.
AU - Pezzini, C.
AU - Vassallo, C.
AU - Rosso, R.
AU - D'Ospina, R. M.
AU - Tomasini, C.
AU - Brazzelli, V.
PY - 2014
Y1 - 2014
N2 - Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterized by an heterogeneous group of severe dermatologic manifestations and systemic involvement, due to several groups of medicaments. A series of 9 consecutive cases, observed from 2008 to 2013 in the Department of Dermatology, University of Pavia, is reported, all satisfying the clinical, hematological and systemic diagnostic criteria of DRESS. Clinically, 4 out of 9 patients had an urticarial and papular eruption, 2 an erythema-multiforme-like (EM-like) pattern, 2 erythroderma and 1 had an erythematous and macular reaction. Aim of the study was to describe the histopathologic features of DRESS and to trace a possible correlation between the four clinical recognized types of the syndrome and the histopathological patterns. Predominantly, a superficial perivascular lymphocytic infiltrate, extravasation of erythrocytes, and focal interface changes characterized DRESS cases. Less frequently, histopathology revealed the presence of necrotic keratinocytes; surprisingly, only in 2 cases the presence of rare dermal eosinophils was detected, even if all the patients had significant peripheral eosinophilia. A histopathological diagnosis of DRESS seems per se, according to our data, not feasible, since the main histopathological changes (interface changes, superficial perivascular dermatitis, focal spongiosis, lichenoid infiltrate, rare presence of necrotic keratinocytes) can be interpreted generically as a drug induced dermatitis. The above mentioned histopathological changes, however, when associated with clinical information on cutaneous and systemic involvement of the patient, allow the pathologist or the dermatopathologist to make a diagnosis of DRESS with a reliable margin of certainty.
AB - Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is characterized by an heterogeneous group of severe dermatologic manifestations and systemic involvement, due to several groups of medicaments. A series of 9 consecutive cases, observed from 2008 to 2013 in the Department of Dermatology, University of Pavia, is reported, all satisfying the clinical, hematological and systemic diagnostic criteria of DRESS. Clinically, 4 out of 9 patients had an urticarial and papular eruption, 2 an erythema-multiforme-like (EM-like) pattern, 2 erythroderma and 1 had an erythematous and macular reaction. Aim of the study was to describe the histopathologic features of DRESS and to trace a possible correlation between the four clinical recognized types of the syndrome and the histopathological patterns. Predominantly, a superficial perivascular lymphocytic infiltrate, extravasation of erythrocytes, and focal interface changes characterized DRESS cases. Less frequently, histopathology revealed the presence of necrotic keratinocytes; surprisingly, only in 2 cases the presence of rare dermal eosinophils was detected, even if all the patients had significant peripheral eosinophilia. A histopathological diagnosis of DRESS seems per se, according to our data, not feasible, since the main histopathological changes (interface changes, superficial perivascular dermatitis, focal spongiosis, lichenoid infiltrate, rare presence of necrotic keratinocytes) can be interpreted generically as a drug induced dermatitis. The above mentioned histopathological changes, however, when associated with clinical information on cutaneous and systemic involvement of the patient, allow the pathologist or the dermatopathologist to make a diagnosis of DRESS with a reliable margin of certainty.
KW - Diagnosis
KW - Drug hypersensitivity syndrome
KW - Drug-related side effects and adverse reactions
UR - http://www.scopus.com/inward/record.url?scp=84905669625&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84905669625&partnerID=8YFLogxK
M3 - Article
C2 - 24819756
AN - SCOPUS:84905669625
VL - 149
SP - 291
EP - 300
JO - Minerva dermatologica
JF - Minerva dermatologica
SN - 0392-0488
IS - 3
ER -