Histopathologic Features in Vancomycin-Associated Drug-Induced Hypersensitivity Syndrome

Area of Science:

• Dermatology
• Pathology
• Pharmacology

Background:

• Drug-induced hypersensitivity syndrome (DiHS), also known as drug reaction with eosinophilia and systemic symptoms (DRESS), is a severe immune reaction to medications.
• Vancomycin is a commonly used antibiotic associated with DiHS/DRESS, often presenting with significant organ involvement.

Purpose of the Study:

• To elucidate the specific histopathology of vancomycin-induced DiHS/DRESS.
• To correlate histopathologic findings with clinical manifestations.

Main Methods:

• Retrospective review of patients diagnosed with probable or definite DiHS/DRESS after vancomycin treatment between 2006 and 2022.
• Dermatopathologic review of skin biopsy specimens.
• Statistical analysis of histopathologic and clinical features.

Main Results:

• Twenty-three patients were included; 87% exhibited an eczematous reaction pattern on skin biopsy.
• Common epidermal findings included spongiosis (87%) and neutrophilic infiltration (91%).
• Parakeratosis correlated with desquamative rash and inversely with liver involvement; epidermal lymphocytes correlated inversely with the RegiSCAR score.

Conclusions:

• Vancomycin-associated DiHS/DRESS histopathology is characterized by a predominant eczematous pattern, often with coexisting patterns and epidermal neutrophilic infiltration.
• Histopathologic features provide insights into clinical presentation and disease severity.