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Allergies and autoimmune diseases may both be considered hyper-immune responses, where the body’s immune system becomes supercharged and attacks or responds to inappropriate antigens. We describe a skin rash with a mixed allergic and autoimmune host response. A 65 year old female consulted her dermatologist for a pruritic rash. The patient had taken many medications without improvement of the rash, and lived in an area affected by environmental spills; other patients had presented with similar rashes concurrently. A clinical evaluation was performed, and skin biopsies were obtained for hematoxylin and eosin (H&E) examination, as well as for immunohistochemical (IHC) and direct immunofluorescence (DIF) studies. The H&E review revealed a mild, superficial, perivascular dermal infiltrate of lymphocytes, histiocytes, mast cells and eosinophils. Dermal sclerodermoid alterations were also noted. A mild peripheral blood eosinophilia was found; cutaneous IHC staining revealed staining for anti-HLA-DP, DQ, DR antigen and Complement/C5b-9/MAC, in the areas of the perivascular infiltrate and the sclerodermoid changes. The DIF confirmed these findings. Our case is characterized by a mixed allergic/autoimmune reaction, which did not fit exclusively into any single Gell Coombs immune response category.\u

A cutaneous rash with mixed gell coombs allergic features, sclerodermoid changes and status post previous therapy