 |
|
Tissue Eosinophilia as an Indicator of Drug-Induced Cutaneous Small-Vessel Vasculitis
Soon Bahrami, MD;
Janine C. Malone, MD;
Kelli G. Webb, MD;
Jeffrey P. Callen, MD
Arch Dermatol. 2006;142:155-161.
Objective To determine whether tissue eosinophilia is a reliable indicator of a drug-induced etiology in biopsy samples demonstrating leukocytoclastic vasculitis.
Design Retrospective medical record review with concurrent histopathologic analysis.
Setting University-affiliated dermatology practice.
Patients Sixty-three patients with cutaneous small-vessel vasculitis meeting specific inclusion criteria were divided into drug-induced (n = 16) and non–drug-induced (n = 47) groups.
Main Outcome Measures Corresponding histopathologic material was reviewed by a dermatopathologist masked to the etiologic associations. An eosinophil ratio was calculated for each patient, derived from the mean eosinophil score (averaging eosinophil counts from 10 high-power histologic fields), and expressed in relation to the intensity of inflammation in the histopathologic slides examined. Eosinophilia ratios were compared for both groups using the Mann-Whitney test.
Results A significant difference was found in mean eosinophil ratios in the drug-induced vs non–drug-induced groups (5.20 vs 1.05; P = .01). Vascular fibrin deposition was present in both groups and was not found to be significantly different (P = .78). Clinical evidence of systemic vasculitis was present in 2 patients (13%) in the drug-induced group vs 15 (32%) in the non–drug-induced group. Fourteen patients (88%) in the drug-induced group had a short-term disease course vs 27 (57%) in the non–drug-induced group.
Conclusions Tissue eosinophilia is established as a reliable indicator of drug induction in cutaneous small vessel vasculitis. Drug-induced small-vessel vasculitis generally follows a short-term disease course without development of systemic involvement. This information may be useful for guiding management decisions, especially when the etiology is unclear.
Author Affiliations: Department of Pathology (Drs Bahrami and Malone) and Division of Dermatology, Department of Internal Medicine (Drs Malone, Webb, and Callen), University of Louisville School of Medicine, Louisville, Ky.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Reflections on Eosinophils and Flame Figures: Where There's Smoke There's Not Necessarily Wells Syndrome.
Leiferman and Peters
Arch Dermatol 2006;142:1215-1218.
FULL TEXT
|
