Acute cutaneous graft-vs.-host disease compared to drug hypersensitivity reaction with vacuolar interface changes: a blinded study of microscopic and immunohistochemical features.
BACKGROUND
Complications from graft-vs.-host disease (GVHD), a major contributor to morbidity and mortality following hematopoietic cell transplantation, may be mitigated by early diagnosis and intervention. However, differentiation between acute cutaneous GVHD and other common skin eruptions that develop in the post-transplantation period, such as drug hypersensitivity reaction, can be challenging clinically and microscopically. Because recent evidence indicates that CD123, a marker of plasmacytoid dendritic cells, can help to distinguish gastrointestinal GVHD from the clinicopathologic mimic cytomegalovirus colitis, we aimed to determine whether CD123 could aid in the diagnosis of acute cutaneous GVHD.


METHODS
We studied 12 skin specimens of patients with grades I-II cutaneous GVHD and 12 from patients who had drug hypersensitivity reaction with vacuolar interface changes on biopsy.


RESULTS
No differences were seen between the two groups with regards to density or distribution of CD123 expression. Specimens representing GVHD showed significantly less spongiosis (P < 0.001) and fewer dermal eosinophils (P = 0.03) compared to those representing drug hypersensitivity reaction.


CONCLUSIONS
We conclude that CD123 does not appear to be a useful ancillary test in the diagnosis of acute cutaneous GVHD. Careful correlation between clinical findings and features with microscopy remains the cornerstone of accurate diagnosis of acute cutaneous GVHD.
Department of Dermatology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
Julia S
JS
Lehman
Lawrence E
LE
Gibson
Rokea A
RA
el-Azhary
Rahul N
RN
Chavan
Shahrukh K
SK
Hashmi
Christine M
CM
Lohse
Thomas J
TJ
Flotte
D001706:Biopsy; D015704:CD4 Antigens / Q000378:metabolism; D003092:Colitis / Q000175:diagnosis / Q000473:pathology / Q000821:virology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D003713:Dendritic Cells / Q000473:pathology; D003937:Diagnosis, Differential; D004342:Drug Hypersensitivity / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007150:Immunohistochemistry; D053650:Interleukin-3 Receptor alpha Subunit / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D012867:Skin / Q000473:pathology
D015704:CD4 Antigens; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; C115022:IL3RA protein, human; D053650:Interleukin-3 Receptor alpha Subunit; D010446:Peptide Fragments; C056725:CD4 (76-94)
GVHD; dendritic cells; histopathology; immunohistochemistry; immunology