背景:将活检标本分类为炎症反应模式是皮肤病理学评估的核心。混合炎症模式特征不明确,可能代表临床病理挑战。这项研究的目的是确定与混合海绵状界面皮炎(SID)组织病理学模式相关的临床和组织病理学发现。
方法:通过回顾性自然语言搜索,在2年的时间内鉴定了51份SID的机构活检标本。确定了组织病理学和临床特征。
结果:与SID相关的最常见的组织病理学特征是轻度海绵体病(51%),局灶性液泡界面改变(72%),淋巴细胞胞吐(92%),和真皮浅层淋巴细胞浸润(94%),嗜酸性粒细胞(61%)。临床上,80%的受试者表现出对称的甲状喷发。多药房(94%),免疫抑制(47%),和恶性肿瘤病史(47%)是常见的。最常见的诊断是药物反应(37%),可能的药物反应(12%),和病毒exanthem(12%)。嗜酸粒细胞增多和全身症状的药物反应占所有确认的皮肤药物不良反应(CADR)的25%。从药物开始到症状开始的平均时间为20天(SD:22.3,范围:0-90);中位疾病持续时间为25.5天。与非药疹相比,在具有强烈临床病理诊断的药物反应的患者中,海绵性囊泡和朗格汉斯细胞较少见(p=0.04)。
结论:混合SID模式通常在CADR中遇到,但可能代表更亚急性的病程,暗示考虑在典型的7到14天窗口之前开始煽动药物。
BACKGROUND: Categorization of biopsy specimens into inflammatory reaction patterns is central to dermatopathologic assessment. Mixed inflammatory patterns are poorly characterized and may represent clinicopathologic challenges. The purpose of this study was to identify clinical and histopathologic findings associated with the mixed
spongiotic-interface dermatitis (SID) histopathologic pattern.
METHODS: Fifty-one institutional biopsy specimens of SID were identified over a 2-year period by retrospective natural language search. Histopathologic and clinical features were identified.
RESULTS: The most common histopathologic features associated with SID were mild spongiosis (51%), focal vacuolar interface change (72%), lymphocytic exocytosis (92%), and superficial-dermal lymphocytic infiltrate (94%) with variable eosinophils (61%). Clinically, 80% of subjects presented with a symmetric morbilliform eruption. Polypharmacy (94%), immunosuppression (47%), and history of malignancy (47%) were common. The most common diagnoses were drug reaction (37%), possible drug reaction (12%), and viral exanthem (12%). Drug reaction with eosinophilia and systemic symptoms represented 25% of all confirmed cutaneous adverse drug reactions (CADR). Average time from drug initiation to symptom initiation was 20 days (SD: 22.3, range: 0-90); median disease duration was 25.5 days.
Spongiotic vesicles and Langerhans cells were less common in patients with a strong clinicopathologic diagnosis of drug reaction compared to non-drug eruptions (p = 0.04).
CONCLUSIONS: The mixed SID pattern is commonly encountered in CADR but may represent a more subacute course, implying consideration for inciting medication(s) started before the typical 7- to 14-day window.