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Cutaneous Histopathologic, Immunohistochemical, and Clinical Manifestations in Patients With Hemophagocytic Syndrome
LTC Kathleen J. Smith, MC;
CDR Henry G. Skelton, MC;
LCDR Josef Yeager, MC;
COL Peter Angritt, MC;
Kenneth Wagner, DO;
COL William D. James, MC;
MAJ Walter J. Giblin, MC;
COL George P. Lupton, MC
Arch Dermatol. 1992;128(2):193-200.
Abstract
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• Background and Design.—
The hemophagocytic syndrome (HPS) is characterized by fever, wasting, generalized lymphadenopathy, hepatosplenomegaly, and pancytopenia, often with associated coagulopathy. The most common cutaneous manifestations are panniculitis and purpura. Cytophagic histiocytic panniculitis fits within the spectrum of HPS, and the most consistent histopathologic feature in HPS is a proliferation of mature histiocytes that exhibit prominent erythrophagocytosis and cytophagocytosis. The clinical spectrum, the underlying causes, and the histopathologic features found in HPS are broad. The characteristic phagocytic histiocytes seen in HPS have been confused with malignant histiocytes in the past, but are now known to be reactive. The clinical findings, histologic, and immunohistochemical features of 10 cases of HPS with cutaneous lesions were reviewed. Immunohistochemical markers included KP-1, βF-1, UCHL-1, L-26, MAC-387, factor XIIIa, and S100 protein.
Results.—
The HPS was associated with T-cell lymphoma and/or viral infection. Most biopsy specimens showed edema and hemorrhage with a lymphohistiocytic infiltrate and prominent histiocytic cells showing erythrophagocytosis and, in some cases, cytophagocytosis. The histiocytic cells showed positive reactions for KP-1 and negative reactions for the lymphoid markers. In all cases the lymphoid cells showed a mixed pattern with most cells positive for βF-1 and UCHL-1, and a small percentage positive for L-26.
Conclusion.—
In HPS, the prominent phagocytic histiocytes are reactive and are stimulated by T-cell lymphocytes, either neoplastic or in response to viral infection. Many of the findings in the HPS may also be due directly or indirectly to cytokines produced by proliferating T-cell lymphocytes and/or reactive phagocytic histiocytes.
(Arch Dermatol. 1992;128:193-200)
Author Affiliations
USA; USN; USN; USA; USA; USA; USA; Military Medical Consortium for Applied Retroviral Research (MMCARR)
From the Department of Dermatopathology (Drs Skelton and Lupton) and AIDS Registry (Dr Angritt), Armed Forces Institute of Pathology, Washington, DC; the Dermatology Service, Fort Dix, NJ (Dr Giblin); the Department of Dermatology, Walter Reed Army Medical Center (Dr James), Walter Reed Army Institute of Research (Dr Smith), Washington, DC; Department of Dermatology (Dr Yeager), and Henry M. Jackson Foundation (Dr Wagner), National Naval Medical Center, Bethesda, Md.
Footnotes
Accepted for publication August 20, 1991.
The opinions or assertions contained herein are the private views of the authors and are not to be considered as official or as reflecting the views of the Departments of the Army or Navy or of the Department of Defense.
Reprint requests to Department of Dermatopathology, Armed Forces Institute of Pathology, Washington, DC 20306 (Dr Skelton).
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