Supplementary Material for: DRESS syndrome that resembles graft versus host disease after chemotherapy in a pediatric patient: A case report

Introduction: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a potentially life-threatening, drug-induced adverse reaction characterized by skin eruptions, lymphadenopathy, fever, and a broad range of other bodily manifestations. The spectrum of histopathologic and clinical presentations is wide; therefore, DRESS syndrome can mimic other diseases. Case Presentation: We present a case of a 4-year-old male patient who started chemotherapy with vincristine, cytarabine, and etoposide. The first clinical signs were fever, hemodynamic in-stability, and maculopapular erythema. Results: Biopsies of skin lesions were taken, and hyper-keratosis, focal parakeratosis, acanthosis with slight spongiosis, and intraepithelial dyskeratotic cells were observed. There was a perivascular lymphoid infiltrate with abundant eosinophils in the dermis, and eosinophil permeations to the acrosyringium and epithelium were found. Conclusion: DRESS syndrome is a drug-induced reaction that shares histopathological findings in skin biopsies with those seen in graft-versus-host disease. Although the histological findings are non-pathognomonic, they were characteristic enough to be of importance in the differential diagnosis.

引言：嗜酸性粒细胞增多伴全身症状药物反应综合征（Drug reaction with eosinophilia and systemic symptoms, DRESS）是一种潜在致命的药物诱导性不良反应，以皮疹、淋巴结肿大、发热及多种其他全身表现为特征。其组织病理学与临床表现谱跨度极大，因此该综合征可酷似其他多种疾病。病例报告：本文报告1例4岁男性患者，该患者在接受长春新碱、阿糖胞苷及依托泊苷联合化疗期间发病，初始临床表现为发热、血流动力学不稳定及斑丘疹样红斑。结果：对皮损进行活检后，观察到角化过度、局灶性角化不全、伴轻度海绵水肿的棘层肥厚，以及上皮内角化不良细胞。真皮层可见血管周围淋巴样浸润伴大量嗜酸性粒细胞，同时发现嗜酸性粒细胞浸润至汗孔部及上皮组织。结论：DRESS综合征是一种药物诱导性反应，其皮肤活检的组织病理学表现与移植物抗宿主病（graft-versus-host disease, GVHD）存在重叠。尽管该组织学表现不具备诊断特异性，但已足够具有特征性，对鉴别诊断具有重要价值。