ABSTRACT
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction between specific drugs, certain herpesviruse types and the immune system of the affected individual and is characterized by an unpredictable course and recurrent flares even after withdrawal of the offending drug and administration of systemic steroids. AIMS: To identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. METHODS: After obtaining ethical clearance from the institutional ethics committee and a written informed consent from individual study participant, the first hundred patients who required inpatient care in Government Medical College, Kozhikode with drug reaction with eosinophilia and systemic symptoms from January 1st 2011 were included in this study aimed to identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. RESULTS: Male-to-female ratio of the study group was 0.8:1. The presence of atypical cells in peripheral smear and advanced age were found to be predictors of disease severity in drug reaction with eosinophilia and systemic symptoms, whereas, sex, facial erythema and edema and absolute eosinophil count were found not to be predictors of the same. LIMITATIONS: The main limitation of this study was our inability to assess the role of human leukocyte antigen (HLA) association and herpes virus reactivation in disease severity in drug reaction with eosinophilia and systemic symptoms. This study was also not designed to evaluate the response to treatment given and the mortality caused by drug reaction with eosinophilia and systemic symptoms. CONCLUSIONS: Studies on the predictors of severity in drug reaction with eosinophilia and systemic symptoms in different population groups may enable us to identify the warning signs and help to formulate the standard therapeutic guidelines.
Subject(s)
Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/epidemiology , Eosinophilia/diagnosis , Eosinophilia/epidemiology , Severity of Illness Index , Adolescent , Adult , Aged , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Young AdultSubject(s)
Enterovirus/isolation & purification , Hand, Foot and Mouth Disease/diagnosis , Hand, Foot and Mouth Disease/epidemiology , Tertiary Care Centers , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Enterovirus/genetics , Female , Hand, Foot and Mouth Disease/genetics , Humans , India/epidemiology , Infant , Male , Real-Time Polymerase Chain Reaction/methods , Tertiary Care Centers/trends , Young AdultABSTRACT
Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction that can affect any age group. We carried out a prospective study of the clinicoepidemiologic aspects of DRESS in children. We prospectively studied all patients ages 12 years and younger admitted to the departments of pediatrics and dermatology at a tertiary care hospital over a 3-year period with probable or definite DRESS, defined based on the RegiSCAR scoring system. A total of 11 patients were studied. Lamotrigine (four patients) and pencillins (three patients) were the most common offending drugs. Not adhering to the standard guidelines of introduction and gradual titration of lamotrigine to therapeutic dose may have increased the chance of lamotrigine-induced DRESS. A short latent period between the onset of drug intake and drug reaction was noted in DRESS induced by antibiotics.
Subject(s)
Drug Hypersensitivity Syndrome , Child , Child, Preschool , Drug Hypersensitivity Syndrome/etiology , Female , Humans , Lamotrigine , Male , Penicillins/adverse effects , Prospective Studies , Triazines/adverse effectsABSTRACT
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.
Subject(s)
Drug Hypersensitivity Syndrome/pathology , Drug Hypersensitivity/pathology , Eosinophilia/pathology , Adult , Biopsy, Needle , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/epidemiology , Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/epidemiology , Eosinophilia/diagnosis , Female , Humans , Immunohistochemistry , Incidence , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment , Sampling Studies , Severity of Illness Index , Young AdultSubject(s)
Lymphocytes/pathology , Sweet Syndrome/diagnosis , Adult , Female , Humans , Recurrence , Sweet Syndrome/therapyABSTRACT
OBJECTIVES: 1. To study and compare the clinical and histological features of Type 1 and Type 2 lepra reactions. 2. To document the histological patterns of Type 1 and Type 2 lepra reactions observed in the study population. DESIGN: Two year cross sectional study. Patients attending the outpatient department of our tertiary care hospital, during the 2 year study period with clinical evidence of Type 1 (T1R) or Type 2 (T2R) lepra reactions were included in this study after obtaining written informed consent. During this period 34 T1R patients and 14 T2R patients attended our hospital. Biopsies were taken from reacting skin lesions of all patients and histological features were studied. RESULTS: Dermal or intragranuloma oedema was evident in 50% of T1R patients and all of them had clinically severe reactions. The T1R patients showed three different histological patterns--pgrading reactions, downgrading reactions and reactions without upgrading or downgrading. Among T2R patients 8/14 showed neutrophil infiltration histologically, 5/14 showed no histological evidence of neutrophil infiltration and only one patient had features of neutrphilic vasculitis. Dermal oedema was seen in 11/14 cases. CONCLUSIONS: Histology revealing dermal or intragranuloma oedema on a background of leprosy granuloma favours the diagnosis of lepra reaction. A careful analysis of subtle variations in the cells constituting the granuloma may aid in differentiating between upgrading T1R, downgrading T1R or T1R without upgrading or downgrading. Histology can also be useful in distinguishing T2R from T1R, in the absence of typical erythema nodosum leprosum (ENL) lesions. Neutrophils are the major inflammatory cells in the former where as lymphocytes or macrophages predominate in the latter. We recommend that histopathological analysis should form an integral part of the evaluation of all lepra reactions.
Subject(s)
Immunity, Cellular , Leprosy/diagnosis , Leprosy/immunology , Ambulatory Care , Biopsy , Cross-Sectional Studies , Dermatology , Erythema Nodosum/diagnosis , Erythema Nodosum/immunology , Erythema Nodosum/microbiology , Erythema Nodosum/pathology , Female , Histology , Humans , India , Leprosy/microbiology , Leprosy/pathology , Male , OutpatientsABSTRACT
A case of chronic disseminated cutaneous histoplasmosis with unusual skin manifestations in an immunocompetent host is reported. Presence of cutaneous ulcers, linear erythematous plaques, skin coloured atrophic plaques and recurrent self-limiting oral ulcers in a single patient has not been documented in literature so far. Diagnosis was established by identifying small intracellular yeast-like cells of Histoplasma in tissue smear and skin biopsy. Leishman stained tissue smear proves to be an easy and simple procedure for diagnosis of histoplasmosis.
