Clinicopathological Differential Diagnosis of Drug-Induced Toxic Epidermal Necrolysis (Lyell’s Syndrome) and Acute Graft-Versus-Host Reaction

Paquet, Philippe; Arrese, Jorge E.; Béguin, Yves; Pierard, Gérald

doi:10.1007/978-3-642-59552-3_3

Cited by 14 publications

(10 citation statements)

References 59 publications

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“…All the authors emphasized the difficulties in establishing a differential diagnosis given the lack of specific clinical or histological criteria. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] These difficulties are partly due to the very low incidence of TEN, resulting in insufficient experience to support the clinicopathological differential diagnosis. We consider that the differential diagnosis is a difficult question, as both diseases share clinical and histological characteristics.…”

Section: Discussionmentioning

confidence: 99%

Stage IV cutaneous acute graft-versus-host disease. Clinical and histological study of 15 cases

Goiriz¹,

Peñas²,

Pérez‐Gala³

et al. 2009

Journal of the European Academy of Dermatology and Venereology

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Section: Discussionmentioning

confidence: 99%

Stage IV cutaneous acute graft-versus-host disease. Clinical and histological study of 15 cases

Goiriz¹,

Peñas²,

Pérez‐Gala³

et al. 2009

Journal of the European Academy of Dermatology and Venereology

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“…This mixed condition typically represents a puzzling diagnostic dilemma [27, 44, 46]. Histopathology of both conditions shows a sparse inflammatory cell infiltrate with keratinocyte apoptosis.…”

Section: Discussionmentioning

confidence: 99%

“…It remains that some patients with GVHR develop a drug-induced TEN or a GVHR-related TEN-like lesion [43–46]. In some instances, the histopathological distinction between both conditions remains notoriously difficult or impossible to establish [27]. …”

Section: Introductionmentioning

confidence: 99%

Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity

et al. 2013

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Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.

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“…Greater risks are generally present during the initial 3 weeks of drug administration, and they are commonly confined to the first 8 weeks of treatment. A severe acute graft-versus-host reaction (GVHR) may look similar to TEN [5,6].…”

Section: Drugs Responsible For Tenmentioning

confidence: 97%

Facing up to toxic epidermal necrolysis

Pierard¹,

Paquet²

2010

Expert Opinion on Pharmacotherapy

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Toxic epidermal necrolysis (TEN) is a rare but life-threatening mucocutaneous adverse drug reaction. The disease is characterized by a specific and extensive destruction of the epidermis and mucosal epithelia, particularly of the mouth, genitalia and eyes. The TEN pathomechanism is probably initiated by a toxic drug metabolism inside keratinocytes, leading to a self-activation of apoptosis and necrosis. These events are boosted by additional effects of T lymphocytes and macrophages. At present there is still a lack of validated mainstay treatment for TEN. However, a few treatment modalities have been reported to halt TEN progression in some patients.

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Clinicopathological Differential Diagnosis of Drug-Induced Toxic Epidermal Necrolysis (Lyell’s Syndrome) and Acute Graft-Versus-Host Reaction

Cited by 14 publications

References 59 publications

Stage IV cutaneous acute graft-versus-host disease. Clinical and histological study of 15 cases

Stage IV cutaneous acute graft-versus-host disease. Clinical and histological study of 15 cases

Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity

Facing up to toxic epidermal necrolysis

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