Track

Clinical Studies

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) or Drug-induced hypersensitivity syndrome (DiHS) is a heterogenous hypersensitivity reaction precipitated by certain medications. Large histopathologic studies of this condition are limited, particularly those focused on one causative agent. Herein, we describe the histopathologic characteristics of 23 patients with vancomycin-associated DRESS/DiHS. A retrospective chart review identified 23 patients between 2006 and 2022 with probable or definite DiHS (per RegiSCAR validation criteria), clinical documentation that vancomycin was a plausible causative medication, and skin biopsies available for review. Archived slides were reviewed by a board-certified dermatopathologist. Patients were 70% female-sex, 100% White, and median age was 60. Hepatic involvement was noted in 78% of patients, renal involvement was documented in 61%, and all were noted to have a morbilliform rash. Biopsies were characterized by a superficial (87%), perivascular (83%) dermal inflammatory infiltrate. Eosinophils were present in the dermis in 69.6% of cases. Epidermal spongiosis was frequently present (87%), which has been previously characterized in DiHS from multiple causes. Epidermal neutrophilic infiltration was also seen in almost all biopsies (91.3%). Vacuolar interface inflammation was seen in 60.9% of cases, and when adnexal structures were present (n=11), all biopsies showed vacuolar interface inflammation involving the adnexa. Additionally, most biopsies (91%) showed a component of eczematous inflammation, three biopsies showed an eczematous pattern alone, 17 (73.9%) showed eczematous and a second reaction pattern. Overall, the histopathological findings for vancomycin-associated DRESS were similarly variable to cause-agnostic DRESS, with a few consistent distinguishing features.