1. Are apoptosis-determining techniques useful to establish an early diagnosis of acute graft-vs-host disease in pediatric patients under treatment with multiple drugs?
- Author
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Rodolfo Rodriguez-Jurado, Chiharu Murata, Marimar Sáez-de-Ocariz, Luz Orozco-Covarrubias, Cecilia Serrano‐Pacheco, Alberto Olaya-Vargas, and Edna Morán-Villaseñor
- Subjects
Drug ,Keratinocytes ,Male ,Pathology ,medicine.medical_specialty ,Histology ,Adolescent ,media_common.quotation_subject ,Graft vs Host Disease ,Apoptosis ,Dermatology ,Disease ,Pathology and Forensic Medicine ,Drug Hypersensitivity ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Pathognomonic ,Follicular phase ,medicine ,Humans ,Child ,media_common ,Retrospective Studies ,Skin ,TUNEL assay ,integumentary system ,medicine.diagnostic_test ,business.industry ,Caspase 3 ,Infant ,medicine.disease ,surgical procedures, operative ,Early Diagnosis ,Proto-Oncogene Proteins c-bcl-2 ,030220 oncology & carcinogenesis ,Case-Control Studies ,Child, Preschool ,Skin biopsy ,Acute Disease ,Female ,business ,Vasculitis - Abstract
There are no pathognomonic histopathological features to distinguish acute graft-vs-host disease (aGVHD) from skin drug reactions (SDRs) in pediatric patients with multiple drug regimens that have received blood transfusions and/or transplants. We aimed to determine if the addition of apoptosis markers is helpful to distinguish aGVHD from SDRs in these patients.Skin biopsy specimens from patients with a clinical diagnosis of aGVHD or SDRs were evaluated for the presence of apoptotic bodies, satellitosis, interface damage, vasculitis, and inflammatory infiltrate on HE stain. Information was completed with apoptotic markers (transferase-mediated dUTP nick end-labeling [TUNEL], bcl-2, and caspase-3).The skin biopsy specimens of 32 patients with aGVHD and 11 with SDRs were included for study. Only the number of apoptotic keratinocytes per 10 high-power fields (hpf) showed a significant difference between both groups (P = 0.02); the presence of ≥4 apoptotic keratinocytes per 10 hpf was identified as the optimal cut-off point to discriminate aGVHD from SDRs. No SDRs cases had follicular apoptotic cells. TUNEL, bcl-2, and caspase-3 determination showed no difference between both groups.The presence of ≥4 apoptotic keratinocytes per 10 hpf (in aGVHD) and the absence of follicular apoptotic cells (in SDRs) might be a useful marker to distinguish between them.
- Published
- 2019