A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants
Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of la...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Ana Maria Abreu Velez [verfasserIn] Vickie M. Brown [verfasserIn] Michael S. Howard [verfasserIn] |
|---|
| Format: |
E-Artikel |
|---|---|
| Sprache: |
Englisch ; Spanisch ; Französisch ; Polnisch |
| Erschienen: |
2016 |
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| Schlagwörter: |
Multiple drug allergy syndrome |
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| Übergeordnetes Werk: |
In: Nasza Dermatologia Online - Our Dermatology Online, 2011, 7(2016), 1, Seite 40-44 |
|---|---|
| Übergeordnetes Werk: |
volume:7 ; year:2016 ; number:1 ; pages:40-44 |
| Links: |
Link aufrufen |
|---|
| DOI / URN: |
10.7241/ourd.20161.9 |
|---|
| Katalog-ID: |
DOAJ073995428 |
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| 520 | |a Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. | ||
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10.7241/ourd.20161.9 doi (DE-627)DOAJ073995428 (DE-599)DOAJ4e40140d65de4e8c85b469213cb393d0 DE-627 ger DE-627 rakwb eng spa fre pol RL1-803 Ana Maria Abreu Velez verfasserin aut A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. Multiple drug allergy syndrome multiple drug intolerance syndrome adverse drug reactions fibrinogen vessels intraepidermal blisters Dermatology Vickie M. Brown verfasserin aut Michael S. Howard verfasserin aut In Nasza Dermatologia Online Our Dermatology Online, 2011 7(2016), 1, Seite 40-44 (DE-627)1760606286 20819390 nnns volume:7 year:2016 number:1 pages:40-44 https://doi.org/10.7241/ourd.20161.9 kostenfrei https://doaj.org/article/4e40140d65de4e8c85b469213cb393d0 kostenfrei http://www.odermatol.com/issue-in-html/2016-1-9/ kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_206 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4305 AR 7 2016 1 40-44 |
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10.7241/ourd.20161.9 doi (DE-627)DOAJ073995428 (DE-599)DOAJ4e40140d65de4e8c85b469213cb393d0 DE-627 ger DE-627 rakwb eng spa fre pol RL1-803 Ana Maria Abreu Velez verfasserin aut A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. Multiple drug allergy syndrome multiple drug intolerance syndrome adverse drug reactions fibrinogen vessels intraepidermal blisters Dermatology Vickie M. Brown verfasserin aut Michael S. Howard verfasserin aut In Nasza Dermatologia Online Our Dermatology Online, 2011 7(2016), 1, Seite 40-44 (DE-627)1760606286 20819390 nnns volume:7 year:2016 number:1 pages:40-44 https://doi.org/10.7241/ourd.20161.9 kostenfrei https://doaj.org/article/4e40140d65de4e8c85b469213cb393d0 kostenfrei http://www.odermatol.com/issue-in-html/2016-1-9/ kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_206 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4305 AR 7 2016 1 40-44 |
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10.7241/ourd.20161.9 doi (DE-627)DOAJ073995428 (DE-599)DOAJ4e40140d65de4e8c85b469213cb393d0 DE-627 ger DE-627 rakwb eng spa fre pol RL1-803 Ana Maria Abreu Velez verfasserin aut A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. Multiple drug allergy syndrome multiple drug intolerance syndrome adverse drug reactions fibrinogen vessels intraepidermal blisters Dermatology Vickie M. Brown verfasserin aut Michael S. Howard verfasserin aut In Nasza Dermatologia Online Our Dermatology Online, 2011 7(2016), 1, Seite 40-44 (DE-627)1760606286 20819390 nnns volume:7 year:2016 number:1 pages:40-44 https://doi.org/10.7241/ourd.20161.9 kostenfrei https://doaj.org/article/4e40140d65de4e8c85b469213cb393d0 kostenfrei http://www.odermatol.com/issue-in-html/2016-1-9/ kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_206 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4305 AR 7 2016 1 40-44 |
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10.7241/ourd.20161.9 doi (DE-627)DOAJ073995428 (DE-599)DOAJ4e40140d65de4e8c85b469213cb393d0 DE-627 ger DE-627 rakwb eng spa fre pol RL1-803 Ana Maria Abreu Velez verfasserin aut A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. Multiple drug allergy syndrome multiple drug intolerance syndrome adverse drug reactions fibrinogen vessels intraepidermal blisters Dermatology Vickie M. Brown verfasserin aut Michael S. Howard verfasserin aut In Nasza Dermatologia Online Our Dermatology Online, 2011 7(2016), 1, Seite 40-44 (DE-627)1760606286 20819390 nnns volume:7 year:2016 number:1 pages:40-44 https://doi.org/10.7241/ourd.20161.9 kostenfrei https://doaj.org/article/4e40140d65de4e8c85b469213cb393d0 kostenfrei http://www.odermatol.com/issue-in-html/2016-1-9/ kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_206 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4305 AR 7 2016 1 40-44 |
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10.7241/ourd.20161.9 doi (DE-627)DOAJ073995428 (DE-599)DOAJ4e40140d65de4e8c85b469213cb393d0 DE-627 ger DE-627 rakwb eng spa fre pol RL1-803 Ana Maria Abreu Velez verfasserin aut A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants 2016 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. Multiple drug allergy syndrome multiple drug intolerance syndrome adverse drug reactions fibrinogen vessels intraepidermal blisters Dermatology Vickie M. Brown verfasserin aut Michael S. Howard verfasserin aut In Nasza Dermatologia Online Our Dermatology Online, 2011 7(2016), 1, Seite 40-44 (DE-627)1760606286 20819390 nnns volume:7 year:2016 number:1 pages:40-44 https://doi.org/10.7241/ourd.20161.9 kostenfrei https://doaj.org/article/4e40140d65de4e8c85b469213cb393d0 kostenfrei http://www.odermatol.com/issue-in-html/2016-1-9/ kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei https://doaj.org/toc/2081-9390 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_206 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4305 AR 7 2016 1 40-44 |
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Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. 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A multiple drug allergy syndrome, multiple drug intolerance syndrome and/or allergic drug reaction with multiple immune reactants |
| abstract |
Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. |
| abstractGer |
Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. |
| abstract_unstemmed |
Background: Adverse drug reactions (ADR), multiple drug allergy syndrome (MDAS) and multiple drug intolerance syndrome (MDIS), are very common in the clinical practice worldwide due to an aging population. Case report: Here we describe a 61 year old Caucasian female, who presented complaining of large, tense bullae on her right anterior arm; the bullae had been present for one week, with pruritus. The patient was taking multiple medications. The patient presented with multiple large, tense blisters and scattered, smaller blisters on her legs and axillae. Materials and Methods: Biopsies for hematoxylin and eosin (H&E) examination, direct immunofluorescence (DIF) and immunohistochemistry (IHC) analysis were performed. The H&E staining demonstrated diffuse, moderate epidermal spongiosis, with a subepidermal blister. Lymphocytes and eosinophils were present within the blister lumen and around superficial dermal blood vessels, hair follicles and sweat glands. Notably, blood vessels and lymphatics had altered shapes, many being narrowed, twisted and or dilated. DIF showed significant deposits of fibrinogen, Complement/C3c and IgA around the dermal vessels; some reactivity was also present at the basement membrane zone of the skin, as well as around dermal skin appendices. Of great interest was the reactivity seen with anti-human fibrinogen against some dermal cell junctions. IHC staining showed the presence of mainly CD4 and BCL-2 positive cells around skin appendices, with a few CD8 positive cells also present. Cyclooxygenase-2 was also very positive around the dermal blood vessels, as well as within cells of the dermal inflammatory infiltrate. The dermal lymphatics and dermal blood vessels appeared dilated, demonstrated by staining for D2-40/podoplanin and von Willembrand factor. Conclusion: Adverse drug reactions and multiple drug allergy syndrome have several overlapping features; the spectrum of immunopathologic and histopathologic features are not fully established. Our case contributes to our knowledge of some of these features. In the authors’ experience, we have noticed that the hallmark of these reactions is the prevalence of strong deposits of fibrinogen in several vessels and dermal skin appendices. In addition, we have noted positivity on some types of dermal cell junctions. MDAS, MDIS and ADRs represent examples of how to categorize adverse, simultaneous reactions to multiple classes of chemically unrelated drugs. |
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