Drug reaction, cyclooxygenase 2, and alteration on lymphatics.

Adverse drug reactions, multiple drug allergy syndrome, and multiple drug intolerance syndrome, are common terms used in clinical practice worldwide. Here we present a 61-year-old Caucasian female, who is diabetic and hypertensive, and started receiving doxycycline for an upper respiratory tract infection. Simultaneously, she selfprescribed Advil.®. The patient has had a previous episode of drug intolerance. In this episode, she presented with a skin rash included bullae on her arms, legs and in part of her abdomen along with some systemic symptoms such fever, cough, and upset stomach. Biopsies for hematoxylin and eosin (H&E), direct immunofluorescence (DIF), and immunohistochemistry (IHC) stain analysis were performed. The diagnosis was made based upon interpretation of the histology in the context of drug reaction with alterations on the dermal lymphatics. DIF showed significant deposits of fibrinogen, complement/C3c and IgA around the dermal vessels, and at the endothelial-mesenchymal dermal cell junctions. IHC staining showed lymphangiectases with strong staining of the lymphatic junctions to the adjacent upper dermis using D2-40 marker. In this case, it is possible that the drug reaction could be causing previously unreported damage in lymphatics, including fragmentation and dilatation. These channels are stimulated inhibited, contracted, and relaxed by interactions with multiple receptors and the inflammation could cause dysregulation in those including their shape. [ABSTRACT FROM AUTHOR]