NDLI: Drug reaction with eosinophilia and systemic symptoms (DRESS): A histopathology based analysis.

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Drug reaction with eosinophilia and systemic symptoms (DRESS): A histopathology based analysis.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Sasidharanpillai, Sarita Govindan, Aparna Riyaz, Najeeba Binitha, Manikoth P. Muhammed, Kunnummal Khader, Anza Reena Mariyath, Olasseri K. Simin, Muhammedkutty Subin, Kunnari
Description	Country affiliation: India Author Affiliation: Sasidharanpillai S ( Department of Dermatology and Venereology, Government Medical College, Kozhikode, Kerala, India.)
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 significance. METHODS: All patients admitted to the dermatology ward of government medical college, Kozhikode from January 1, 2014 to December 31, 2014 with probable or definite 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 finding documented was the predominantly lymphocytic dermal inflammatory infiltrate. Four of the five 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 flares. The presence of atypical lymphocytes in peripheral smear and histological evidence of dense dermal inflammatory infiltrate 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 infiltrate (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 inflammatory infiltrate, tissue eosinophilia and interface dermatitis with or without keratinocyte necrosis was associated with a poor prognosis.
File Format	HTM / HTML
ISSN	03786323
e-ISSN	09733922
Journal	Indian Journal of Dermatology, Venereology, and Leprology
Issue Number	1
Volume Number	82
Language	English
Publisher	Medknow Publications
Publisher Date	2016-01-01
Publisher Place	India
Access Restriction	Open
Subject Keyword	Discipline Sexually Transmitted Diseases Discipline Tropical Medicine Discipline Dermatology Drug Hypersensitivity Syndrome Pathology Drug Hypersensitivity Eosinophilia Biopsy, Needle Diagnosis Epidemiology Immunohistochemistry Prognosis Retrospective Studies Risk Assessment Sampling Studies Severity Of Illness Index
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Dermatology

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