Toxic Epidermal Necrolysis and Graft-versus-Host Reaction: Revisiting a Puzzling Similarity

Abstract

Drug-induced toxic epidermal necrolysis (TEN) and acute cutaneous graft-versus-host reaction (GVHR) under immunopreventive therapy share some histopathological resemblance. So far, there are no serum biomarkers and no immunohistochemical criteria distinguishing with confidence and specificity the skin lesions of TEN and GVHR. Both diseases present as an inflammatory cell-poor necrotic reaction of the epidermis. This report compares three sets of 15 immunostaining patterns found in TEN, GVHR, and partial thickness thermal burns (PTTB), respectively. Three series of 17 skin biopsies were scrutinized. Irrespective of the distinct causal pathobiology of TEN and GVHR, similar secondary effector cells were recruited in lesional skin. Burns were less enriched in cells of the monocyte-macrophage disease. These cells likely exert deleterious effects in TEN and GVHR and cannot be simply regarded as passive bystanders. These life-threatening conditions are probably nursed, at least in part, by macrophages.

Erythema multiforme, Stevens–Johnson syndrome and toxic epidermal necrolysis: a comparative review

“…Some cases described in the literature as TEN may be questionable, because significant dermal necrosis was reported . Distinguishing TEN histologically from acute graft‐versus‐host disease can be a major problem in transplantation patients …”

“…132 Distinguishing TEN histologically from acute graftversus-host disease can be a major problem in transplantation patients. 115,133 Differential diagnosis Erythema multiforme…”

Protomyofibroblast Pathway in Early Thermal Burn Healing

“…The monoclonal Mac 387 antibody recognizes the cytosolic L1 protein complex (calprotectin). The L1 antigen is a calcium-binding protein associated with the cytoskeleton of neutrophils, eosinophils, monocytes [32] and in a subset of reactive macrophages during the early stage of monocyte/macrophage differentiation [33]. …”

Toxic epidermal necrolysis in a child 6 months post‐hematopoietic stem cell transplantation

“…GVHD is one of the major complications of HSCT and it is also responsible for post‐therapeutic morbidity, quality of life, and mortality. TEN and cutaneous GVHD share some histopathological resemblance, and the distinction between both conditions remains difficult or impossible to be determined …”