Inês Coutinho

José Cardoso

Margarida Gonçalo

Miguel Gouveia

Neide Pereira

Rita Cabral

Óscar Tellechea

Clinical and Translational Allergy

PubMed

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ORAL PRESENTATION Open Access
Histopathology of the exanthema in DRESS in
correlation with markers of severe systemic
involvement
Margarida Gonçalo*, Inês Coutinho, Miguel Gouveia, Rita Cabral, Neide Pereira, José Carlos Cardoso,
Óscar Tellechea
From 6th Drug Hypersensitivity Meeting (DHM 6)
Bern, Switzerland. 9-12 April 2014
Background
Exanthema in DRESS is considered to have no specific
clinical features similarly to histopathology, performed
systematically in a few studies. Nevertheless, histologic
findings may be related with systemic symptoms.
Objective
We characterized histopathologic findings in DRESS and
correlated them with the severity of the systemic involve-
ment, the culprit drug or HHV-6 reactivation.
Methods
Skin biopsies performed in in-patients with a diagnosis of
DRESS according to REGISCAR criteria, were indepen-
dently evaluated by two Dermatopathologists. Epidermal
and dermal parameters were scored (lymphocyte, eosino-
phil and neutrophil infiltrate, lymphocyte exocytosis,
spongiosis and necrotic/vacuolated keratinocytes) and
correlated with the severity of systemic symptoms (eosino-
philia, liver cytolysis and cholestasis, evaluated respectively
by serum ALT and GGT values) and the presence of
circulating HHV-6 DNA.
Results
In 15 patients (9M/6F, mean age 53.3y) with DRESS
mainly from allopurinol (8) or anticonvulsants (5), we
observed an exfoliative erythroderma (3) or maculopapular
exanthema (12), with facial edema (9), lip/oral erosions (2),
atypical targets (2), flaccid bullae (1), purpura (2) and
pustules (2). Histopathology showed, in variable intensity
and proportions, a lymphocyte and/or eosinophil dermal
infiltrate, lymphocyte exocytosis, spongiosis, necrotic/
vacuolated keratinocytes, combining in a more eczema-
tous, lichenoid, erythema multiforme-like or pseudolym-
phomatous-like reaction. There was a significant positive
correlation between the score of lymphocyte infiltration
and the severity of hepatic cytolysis and circulating eosino-
phils (for both, Pearson’ coefficient r=0.51, p<0.05), but no
correlation between the score for epidermal damage
(keratinocyte vacuolization/necrosis) and systemic invol-
vement, or correlation with the culprit drug or viral
reactivation.
Conclusions
Severity of liver cytolysis was correlated with the intensity
of the dermal infiltrate, but not with the intensity of
epidermal damage, as previously described. Although
DRESS histopathology cannot be used as a diagnostic tool
it can be an additional prognostic marker, but more
studies are needed. There were clinic and, also, histologic
aspects common to SJS/TEN (bullous forms with
epidermal cytolysis) and maculopapular exanthema,
suggesting possible overlapping patterns between DRESS
and these drug eruptions.
Published: 18 July 2014
doi:10.1186/2045-7022-4-S3-O8
Cite this article as: Gonçalo et al.: Histopathology of the exanthema in
DRESS in correlation with markers of severe systemic involvement.
Clinical and Translational Allergy 2014 4(Suppl 3):O8.
Clinic of Dermatology, Faculty of Medicine, University of Coimbra, University
Hospital, Coimbra, Portugal
Gonçalo et al. Clinical and Translational Allergy 2014, 4(Suppl 3):O8
http://www.ctajournal.com/content/4/S3/O8
© 2014 Gonçalo et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


Histopathology of the exanthema in DRESS in correlation with markers of severe systemic involvement

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Histopathology of the exanthema in DRESS in correlation with markers of severe systemic involvement

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