Haley Naik1, Stephen Lockwood2,3, Arturo Saavedra2,3. 1. Department of Dermatology, University of California, San Francisco, California. 2. Harvard Medical School, Boston, Massachusetts. 3. Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Stage 4 skin graft-versus-host disease (GVHD) is associated with poor prognosis and high mortality rates. Clinical and histologic similarities with toxic epidermal necrolysis (TEN) make it difficult to distinguish between these 2 life-threatening conditions. METHODS: A retrospective cohort study was conducted from a tertiary referral center. Skin biopsies were obtained from 11 patients who developed stage 4 skin GVHD and 11 patients who developed TEN between 2005 and 2012. The CD8+/CD4+ T lymphocyte ratios were assessed in lesional skin specimens. RESULTS: Average CD8+and CD4+ cell counts co-expressing CD3 were 126.29 (range 86.42-173.06) and 84.60 (29.87-197.20) for stage 4 skin GVHD patients, and 61.97 (45.79-146.67) and 7.65 (0.00-39.50) for TEN patients, respectively. Immunohistochemical studies of stage 4 skin GVHD and TEN skin demonstrated average CD8+/CD4+ ratios of 1.78 (range 0.69-3.09) and 7.33 (1.16-12.3), respectively (P = .013). CONCLUSIONS: Stage 4 skin GVHD and TEN are processes with cytotoxic profiles. TEN is notable for a greater relative depletion of CD4+ T lymphocytes compared with stage 4 skin GVHD, while stage 4 skin GVHD tends to be more inflammatory than TEN. These data suggest an immunohistologic method by which these 2 entities may be distinguished.
BACKGROUND: Stage 4 skin graft-versus-host disease (GVHD) is associated with poor prognosis and high mortality rates. Clinical and histologic similarities with toxic epidermal necrolysis (TEN) make it difficult to distinguish between these 2 life-threatening conditions. METHODS: A retrospective cohort study was conducted from a tertiary referral center. Skin biopsies were obtained from 11 patients who developed stage 4 skin GVHD and 11 patients who developed TEN between 2005 and 2012. The CD8+/CD4+ T lymphocyte ratios were assessed in lesional skin specimens. RESULTS: Average CD8+and CD4+ cell counts co-expressing CD3 were 126.29 (range 86.42-173.06) and 84.60 (29.87-197.20) for stage 4 skin GVHDpatients, and 61.97 (45.79-146.67) and 7.65 (0.00-39.50) for TEN patients, respectively. Immunohistochemical studies of stage 4 skin GVHD and TEN skin demonstrated average CD8+/CD4+ ratios of 1.78 (range 0.69-3.09) and 7.33 (1.16-12.3), respectively (P = .013). CONCLUSIONS: Stage 4 skin GVHD and TEN are processes with cytotoxic profiles. TEN is notable for a greater relative depletion of CD4+ T lymphocytes compared with stage 4 skin GVHD, while stage 4 skin GVHD tends to be more inflammatory than TEN. These data suggest an immunohistologic method by which these 2 entities may be distinguished.
Authors: Julia S Lehman; Shahrukh K Hashmi; Hillard M Lazarus; Rokea A El-Azhary; Lawrence E Gibson; William J Hogan; Mark R Litzow; Mrinal S Patnaik; Francis Buadi; Martha Q Lacy; Surendra Dasari; Patrick Vanderboom; Alexander Meves Journal: J Cutan Pathol Date: 2017-09-14 Impact factor: 1.587