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Salt and pepper staining patterns for LAT, ZAP-70 and MUM-1 in a vasculitic bullousallergic drug eruption

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Author(s): Abreu Velez Ana Maria | Jackson Billie L. | Howard Michael S.

Journal: Our Dermatology Online
ISSN 2081-9390

Volume: 2;
Issue: 3;
Start page: 104;
Date: 2011;
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Keywords: vasculitides | bullous allergic drug reaction | LAT | ZAP-70 | MUM 1 | skin

ABSTRACT
Background. The term bullous drug eruption refers to clinically adverse drug reactions that result in fluid-filled blisters or bullae. Blistering can be elicited by multiple medications, prescribed or over-the-counter, natural or synthetic. Case Report: A 78-year-old female was evaluated for the presence of a rapidly appearing, diffuse rash with vesicles, bullae and abdominal edema. Methods: Skin biopsies for hematoxylin and eosin examination, as well as for direct immunofluorescence and immunohistochemistry analysis were performed. Results: H&E staining demonstrated a subepidermal blistering disorder. Within the dermis, a mild, superficial, perivascular infiltrate of lymphocytes, histiocytes and eosinophils was seen. No frank leukocytoclastic vasculitis was appreciated. Direct immunofluorescence revealed a strong presence of Complement/C3, IgM and fibrinogen in the upper dermal blood vessels. Staining with LAT, MUM-1, and ZAP-70 was identified in the inflamed vessels, in a delicate salt and pepper pattern. Conclusions: In bullous drug eruptions, inflammation of the dermal blood vessels without frank leuckocytoclasis is often noted; vascular alterations subjacent to the blisters are frequently described as nonspecific. We document specific activation markers of the T cell immune response; further secondary cell signaling pathway molecules are overexpressed in dermal blood vessels, indicative of a complex immune response in these patients
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