Tissue Eosinophilia as an Indicator of Drug-Induced Cutaneous Small-Vessel Vasculitis

Abstract

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 smallvessel vasculitis meeting specific inclusion criteria were divided into drug-induced (n = 16) and non-druginduced (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.

Leukocytoclastic Vasculitis Drug Reaction to Certolizumab Pegol

“…Microscopic evaluation of the right leg infi ltrate to a mononuclear-predominant infi ltrate (7). Furthermore, drug-induced LCV is often characterized as having an eosinophilic-predominant infi ltrate (8). CZP is approved for treatment of psoriatic arthritis in many countries, including the US (1).…”

Pathology of the Cutaneous Vasculitides: A Comprehensive Review

“…Skin biopsy usually reveals a leukocytoclastic vasculitis (LCV) similar to that seen in other small vessel vasculitis syndromes characterized by vascular and interstitial neutrophilic infiltration, leukocytoclasis, endothelial cell swelling, fibrinoid necrosis, and extravasation of red blood cells (Bahrami et al, 2006). Determining a drug induced versus non-drug induced etiology is a diagnostic dilemma for clinicians and pathologists.…”

“…Determining a drug induced versus non-drug induced etiology is a diagnostic dilemma for clinicians and pathologists. Tissue eosinophilia can be present in drug induced LCV, however, its existence does not exclude other nondrug induced etiologies such as arthropod assault, which will also show prominent interstitial eosinophils (Bahrami et al, 2006). One study suggested the presence of vascular fibrin deposition should exclude a drug related LCV, however, later studies have failed to replicate this findings (Bahrami et al, 2006;Mullick et al, 1979).…”

“…Tissue eosinophilia can be present in drug induced LCV, however, its existence does not exclude other nondrug induced etiologies such as arthropod assault, which will also show prominent interstitial eosinophils (Bahrami et al, 2006). One study suggested the presence of vascular fibrin deposition should exclude a drug related LCV, however, later studies have failed to replicate this findings (Bahrami et al, 2006;Mullick et al, 1979). Intravascular fibrin thrombi and epidermal changes including vesicle formation can occasionally be seen (Bahrami et al, 2006).…”

Drug Induced Small Vessel Vasculitis

“…Approximately 20% of cases of cutaneous vasculitis represent an adverse drug eruption and most will represent so-called hypersensitivity vasculitis (CLA) and exhibit a superficial dermal, small-vessel neutrophilic vasculitis or lymphocytic vasculitis (Carlson & Chen, 2006;Carlson & Chen, 2007). Identification of tissue eosinophilia in these biopsies is a clue to a drug etiology (Bahrami S, 2006). Pharmacological classes involved in drug-induced vasculitis are: 1. an ANCA-associated group, such as propylthiouracil, hydralazine, allopurinol, minocycline, penicillamine, and phenytoin; 2. an ANCA-negative group, such as colony-stimulating factors, isotretinoin, and methotrexate (Holder SM et al, 2002).…”