title: Histopathology of drug rash with eosinophilia and systemic symptoms syndrome: a morphological and phenotypical study.
abstract: BACKGROUND
  The histopathological features of drug rash with eosinophilia and systemic symptoms (DRESS) syndrome remain poorly characterized.
  
  
  OBJECTIVE
  To better characterize the histopathological features of DRESS syndrome, and define the phenotype of the effector cells in the skin and compare it with maculopapular rash (MPR).
  
  
  METHODS
  We conducted a retrospective study on 50 skin biopsies from patients with DRESS syndrome (n = 36). Histopathological and immunophenotypical features were studied and compared with a series of MPRs (n = 20).
  
  
  RESULTS
  Foci of interface dermatitis, involving cutaneous adnexae, were frequently seen in cases of DRESS. Eosinophils were seen in only 20% of cases and neutrophils in 42%. Eczematous (40%), interface dermatitis (74%), acute generalized exanthematic pustulosis-like (20%) and erythema multiforme-like (24%) patterns were observed. The association of two or three of these patterns in a single biopsy was significantly more frequent in cases of DRESS than in a series of nondrug-induced dermatoses (P < 0.01), and appeared to be more marked in DRESS syndrome with severe cutaneous lesions (P = 0.01) than in less severe cases of DRESS and MPR. A higher proportion of CD8(+) and granzyme B(+) lymphocytes was observed in cases of DRESS with severe cutaneous eruptions (erythroderma and/or bullae). Atypical lymphocytes were found in 28% of biopsies, and expressed CD8 in most cases; a cutaneous T-cell clone was rarely found (6%).
  
  
  CONCLUSIONS
  The histopathology of DRESS syndrome highlights various associated inflammatory patterns in a single biopsy. Cutaneous effector lymphocytes comprise a high proportion of polyclonal CD8(+) granzyme B(+) T lymphocytes.
authors: Département de Pathologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.|INSERM U955 équipe 9, Hôpital Henri-Mondor, 94010, Créteil Cedex, France.|Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.
authors: N
authors: N
authors: Ortonne
authors: Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.|Service de Dermatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: L
authors: L
authors: Valeyrie-Allanore
authors: Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.|Service de Santé-Publique, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: S
authors: S
authors: Bastuji-Garin
authors: Département de Pathologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: J
authors: J
authors: Wechsler
authors: Département de Pathologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: S
authors: S
authors: de Feraudy
authors: Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.|Service de Dermatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: T-A
authors: TA
authors: Duong
authors: INSERM U955 équipe 9, Hôpital Henri-Mondor, 94010, Créteil Cedex, France.|Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.|Service d'Immunologie Biologique, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: M-H
authors: MH
authors: Delfau-Larue
authors: Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.|Service de Dermatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: O
authors: O
authors: Chosidow
authors: Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.|Service de Dermatologie, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Henri-Mondor, 94010, Créteil Cedex, France.
authors: P
authors: P
authors: Wolkenstein
authors: Université Paris Est Créteil (UPEC), Faculté de Médecine, LIC EA4393, 94010, Créteil Cedex, France.
authors: J-C
authors: JC
authors: Roujeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000493:Allopurinol / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001402:B-Lymphocytes / Q000276:immunology; D002220:Carbamazepine / Q000009:adverse effects; D063926:Drug Hypersensitivity Syndrome / Q000276:immunology / Q000473:pathology*; D005076:Exanthema / Q000139:chemically induced / Q000276:immunology / Q000473:pathology; D005260:Female; D006074:Gout Suppressants / Q000009:adverse effects; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000009:adverse effects; D010641:Phenotype; D012189:Retrospective Studies; D012460:Sulfasalazine / Q000009:adverse effects; D013601:T-Lymphocytes / Q000276:immunology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D006074:Gout Suppressants; D002220:Carbamazepine; D012460:Sulfasalazine; D000493:Allopurinol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008911:Minocycline