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Histopathological analysis and clinical correlation of drug reaction with eosinophilia and systemic symptoms ( DRESS )
Author(s) -
Chi M.H.,
Hui R.C.Y.,
Yang C.H.,
Lin J.Y.,
Lin Y.T.,
Ho H.C.,
Chung W.H.,
Kuo T.T.
Publication year - 2014
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.12783
Subject(s) - spongiosis , medicine , eosinophilia , pathological , vacuolization , dermatology , pathology , eosinophilic , hyperkeratosis , dyskeratosis
Summary Background Drug reaction with eosinophilia and systemic symptoms ( DRESS ) is a severe cutaneous adverse drug reaction. However, its histopathological features have not been well defined. Objectives To identify the clinicohistopathological findings of DRESS , and analyse the cutaneous histopathological changes observed in DRESS compared with those observed in maculopapular exanthema ( MPE ). Methods In a retrospective study, conducted at Chang Gung Memorial Hospital (Taiwan) between 2001 and 2011, we compared the clinicohistopathological features of 32 patients with probable/definite DRESS (defined by the Regi SCAR scoring system) with those of 17 patients with MPE . Results The major pathological changes observed in patients with DRESS included dyskeratosis (97%), epidermal spongiosis (78%), interface vacuolization (91%), perivascular lymphocytic infiltration (97%) and eosinophilic infiltration (72%). Many pathological features were common to both MPE and DRESS . However, severe dyskeratosis, epidermal spongiosis and severe interface vacuolization were significantly more prominent in cases of DRESS ( P < 0·05). The presence of severe dyskeratosis was significantly associated with the clinical severity of renal impairment ( P = 0·01). Conclusions The severe dyskeratosis detected in patients with DRESS may correlate with a greater extent of systemic involvement compared with that noted in MPE . However, the histopathological changes associated with DRESS are not entirely specific.