Interstitial granulomatous drug reaction with a histological pattern of interstitial granulomatous dermatitis
Interstitial granulomatous drug reaction with a histological pattern of interstitial granulomatous dermatitis
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DOI：
10.1097/00000372-200108000-00003
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发表时间：
2001-08-01
影响因子：
1.1
通讯作者：
Michiels, JF
中科院分区：
文献类型：
--
作者：
Perrin, C;Lacour, JP;Michiels, JF
间质肉芽肿性药物反应(IGDR)是一种新的药物相关性实体，以紫罗兰斑块为特征，倾向于皮肤皱褶区。光镜下，它类似于环形肉芽肿的早期弥漫性间质阶段。不同的光镜特征包括没有完全的胶原坏死，存在界面性皮炎，以及可变的淋巴样异型性。无血管炎排除了与全身疾病相关的血管外坏死性肉芽肿(文氏肉芽肿)。Ackerman等人定义的间质性肉芽肿性皮炎与关节炎的鉴别诊断。直到现在才被研究过。我们的目的是确定组织学标准，使我们能够区分无界面性皮炎和淋巴组织异型性的IGDR和间质性肉芽肿性皮炎。我们报告了3例IGDR患者，其中2例分别由血管紧张素转换酶(ACE)抑制剂和速尿触发，1例由血管紧张素转换酶(ACE)抑制剂速尿和氟喹酮联合触发。组织学检查显示间质肉芽肿性皮炎的组织学类型。我们在网状真皮内发现密集弥漫的组织细胞浸润物，分布于间质和栅栏状排列。嗜酸性粒细胞和一些中性粒细胞散在分布于浸润液中。在一些被组织细胞包裹的微小病灶中，可见与嗜碱性核碎片或“火焰图形”相关的厚厚的胶原束。无血管炎、界面性皮炎或淋巴样异型性。我们的研究使我们能够扩大IGDR的组织学范围，包括一种类似于间质性肉芽肿性皮炎的组织学模式。缺乏退化的胶原蛋白可能是一个微妙的线索，有利于间质肉芽肿性皮炎引发的药物。
The interstitial granulomatous drug reaction (IGDR) is a novel drug-associated entity, characterized by violaceous plaques With a predilection for skin fold areas. Light microscopically, it resembles the incipient diffuse interstitial phase of granuloma annulare. Differentiating light microscopic features include the absence of complete collagen necrobiosis, the presence of interface dermatitis, and variable lymphoid atypia. The lack of vasculitis rules out the extravascular necrotizing granuloma (Winkelmarm granuloma) associated with systemic disease. The differential diagnosis with interstitial granulomatous dermatitis with arthritis as defined by Ackerman et al. has not been studied until now. Our aim was to determine the histologic criteria allowing us to differentiate IGDR without interface dermatitis and lymphoid atypia from interstitial granulomatous dermatitis. We report three patients with IGDR triggered, in two cases by respectively angiotensin convertin enzyme (ACE) inhibitors and furosemide, and in one case by the association of an ACE inhibitor; furosemide, and fluindione. Histologic examination showed a histological pattern of interstitial granulomatous dermatitis. We found a dense, diffuse histiocytic infiltrate distributed interstitially and in palisaded array within the reticular dermis. Eosinophils and some neutrophils were scattered throughout the infiltrate. In some tiny foci, enveloped by histiocytes, thick collagen bundles associated with basophilic nuclear debris or "flame figures" were seen. Vasculitis, interface dermatitis, or lymphoid atypia were absent. Our study allowed us to expand the histological spectrum of IGDR including a histological pattern similar to interstitial granulomatous dermatitis. The lack of degenerated collagen could be a subtle clue in favor of interstitial granulomatous dermatitis triggered by a drug.