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  • Presentation

What's New: Inpatient Dermatopathology

Description

The presentation discusses recent advances in inpatient dermatopathology, focusing on toxic erythema from chemotherapy, mimicking conditions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). It highlights the complexity of diagnosing skin reactions in patients undergoing treatment, particularly concerning agents like infortumab and its associated cutaneous toxicity. Additionally, the presentation covers differential diagnosis challenges, such as differentiating acute graft-versus-host disease (GVHD) from SJS, emphasizing the importance of distinguishing histopathologic features, including the nature of inflammatory infiltrates and the presence of eosinophils. It stresses the role of dermatopathologists in guiding treatment decisions based on biopsy results, particularly regarding the continuation of potentially life-saving therapies. Other conditions presented, like Sidriff and drug eruptions, illustrate the intricate patterns and features that can complicate diagnoses in dermatopathology. The speaker concludes by underscoring the key differentiators that help in recognizing specific dermatitis conditions, advocating for thorough examination and understanding of clinical features to aid accurate diagnoses.

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Conclusions

  • Confusion in nomenclature emerges around Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis, complicating diagnosis.
  • Toxic erythema of chemotherapy is a significant reaction associated with Enfortumab vedotin and notable in nearly half of treated patients.
  • Skin toxicity from Enfortumab vedotin may lead to severe reactions necessitating treatment discontinuation and careful differential diagnosis from similar syndromes.
  • Toxic erythema should be properly identified to ensure appropriate management and continuation of effective therapy in patients receiving PD-1 inhibitors.
  • Subepidermal neutrophils and spongiosis are key histopathological features that differentiate acute graft-versus-host disease from toxic epidermal necrolysis.
  • Desmoplakin immunohistochemistry can aid in distinguishing graft-versus-host disease from EM/SJS/TEN spectrum disorders.
  • In drug eruptions, a sparse inflammatory infiltrate favors aGVHD while more profuse eosinophilic infiltration suggests a drug-induced origin.
  • Distinct histological findings can aid in differentiating SDRIFE and its mimics from other blistering conditions to ensure accurate diagnosis.
  • Coordination between dermatopathology and clinical assessment is crucial for effective patient management in cases involving complex dermatological reactions.
  • Hirotsu KE, Rana J, Wang JY, Raghavan SS, Rieger KE, Srinivas S, Fan AC, Kwong BY, Novoa RA, Zaba LC. Clinicopathologic characterization of enfortumab vedotin-associated cutaneous toxicity in patients with urothelial carcinoma. J Am Acad Dermatol. 2021 Dec;85(6):1610-1611.
  • Birmingham SW, Moon DJ, Kraus CN, Lee BA. Enfortumab Vedotin-Associated Toxic Epidermal Necrolysis-like Toxic Erythema of Chemotherapy. Am J Dermatopathol. 2022 Jul 19.
  • Cho WC, et al. Nectin-4 expression in a subset of cutaneous adnexal carcinomas: A potential target for therapy with enfortumab vedotin. J Cutan Pathol. 2024 Jan 10.
  • Santoni M, Takeshita H, Massari F, Bamias A, Cerbone L, Fiala O, Mollica V, Buti S, Santoni A, Bellmunt J. Pembrolizumab plus enfortumab vedotin in urothelial cancer. Nat Rev Urol. 2024 Jan 24.
  • Zameer U, Shaikh W. A new era for bladder cancer: Enfortumab vedotin and pembrolizumab milestone approval. Tumori. 2023 Dec 23:3008916231221508.
  • Khan S et al. Revisiting the "jelly-roll" technique: New utility in diagnosing linear IgA bullous dermatosis mimicking toxic epidermal necrolysis. JAAD Case Rep. 2023 Sep 14;41:75-76.
  • Kwinta BD, Queen D, Husain S, Gallitano SM. Drug-Induced Linear IgA Bullous Dermatosis Mimicking Stevens-Johnson Syndrome Treated With Etanercept: A Case Report. Am J Dermatopathol. 2023 Mar 1;45(3):189-191.
  • Garel B, Ingen-Housz-Oro S, Afriat D, Prost-Squarcioni C, Tétart F, Bensaid B, Bara Passot C, et al. Drug-induced linear immunoglobulin A bullous dermatosis: A French retrospective pharmacovigilance study of 69 cases. Br J Clin Pharmacol. 2019 Mar;85(3):570-579.
  • Hadavand MA, Kaffenberger B, Cartron AM, Trinidad JCL. Clinical presentation and management of atypical and recalcitrant acute generalized exanthematous pustulosis. J Am Acad Dermatol. 2022 Sep;87(3):632-639.
  • Hung YT, Chang YR, Wang HN, Lee WC, Lee CF, Chen CB. Diagnostic and therapeutic dilemma in Stevens-Johnson syndrome-like acute graft-versus-host disease after liver transplantation: A case report. Front Immunol. 2022 Aug 18;13:917782
  • Hung YT, Chen YW, Huang Y, Lin YJ, Chen CB, Chung WH. Acute graft-versus-host disease presenting as Stevens-Johnson syndrome and toxic epidermal necrolysis: A retrospective cohort study. J Am Acad Dermatol. 2023 Apr;88(4):792-801.
  • Kaur M, Singh N, Mital R, Schenk A, Fisher K, Korman AM, Kaffenberger BH, Chung CG. Dermatologic manifestations of acute graft versus host disease after liver transplantation: A case series of 8 patients. JAAD Case Rep. 2023 Jul 6;39:6-13.
  • Tisack A, Konda S, Veenstra J. The diagnostic conundrum of acute cutaneous graft-versus-host disease: biomarkers remain elusive. Arch Dermatol Res. 2023 Oct;315(8):2467-2469.
  • Valencia J, Kaza V, Kim JK, Oliver D, Vandergriff T, Wysocki C, Dominguez AR. Acute graft-versus-host disease after double lung transplant confirmed by short tandem repeat analysis to identify donor chimerism in the skin. JAAD Case Rep. 2023 Apr 7;36:24-27.
  • Irwin T, Yeung CCS, Shinohara MM. Desmoplakin I/II immunohistochemical staining may be a helpful tool in differentiating cutaneous graft versus host disease from the erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis spectrum disorders. J Cutan Pathol. 2024 Jan;51(1):76-82.
  • Chanprapaph K, Leerunyakul K, Niparuck P, Rutnin S. A clinical and histological comparison between acute cutaneous graft-versus-host disease and other maculopapular eruptions following hematopoietic stem cell transplantation: a retrospective cohort. Int J Dermatol. 2021 Jan;60(1):60-69.
  • Russell AJ, Musiek AC, Staser KW, Rosman IS. Histopathologic and immunophenotypic features of cutaneous solid organ transplant-associated graft-vs-host disease: Comparison with acute hematopoietic cell transplant-associated graft-vs-host disease and cutaneous drug eruption. J Cutan Pathol. 2021 Dec;48(12):1480-1488.
  • Chang LW, Doan LT, Fields P, Vignali M, Akilov OE. The Utility of T-Cell Clonality in Differential Diagnostics of Acute Graft-versus-Host Disease from Drug Hypersensitivity Reaction. J Invest Dermatol. 2020 Jun; 140(6):1282-1285.
  • Bonamigo RR, Bottega GB, Staub FL, Almeida RO, Werka HMG. Bullous SDRIFE and Covid-19. Int J Dermatol. 2022 Mar;61(3):372-374.
  • Chaudet KM, et al. Characterization of T-Helper Immune Phenotype in Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) Endorses a Delayed-Type Hypersensitivity Reaction. Am J Dermatopathol. 2024 Feb 1;46(2):71-78.
  • Schuler AM, Smith EH, Chaudet KM, Bresler SC, Gudjonsson JE, Kroshinsky D, Nazarian RM, Chan MP. Symmetric drug-related intertriginous and flexural exanthema: Clinicopathologic study of 19 cases and review of literature. J Cutan Pathol. 2021 Dec;48(12):1471-1479.
  • Harrison I, Patel B, Kunzler E, Walker A, Missall T, Motaparthi K. Dermatopathologist accuracy in classifying angioinvasive fungal infections using virtual microscopy. J Cutan Pathol. 2024 Feb 17.