A cutaneous rash with mixed gell coombs allergic A cutaneous rash with mixed gell coombs allergic features, sclerodermoid changes and status post features, sclerodermoid changes and status post previous therapy

Abstract

Allergies and autoimmune diseases may both be considered hyper-immune responses, where the body’s immune system becomes supercharged and attacks or responds to inappropriate antigens. We describe a skin rash with a mixed allergic and autoimmune host response. A 65 year old female consulted her dermatologist for a pruritic rash. The patient had taken many medications without improvement of the rash, and lived in an area affected by environmental spills; other patients had presented with similar rashes concurrently. A clinical evaluation was performed, and skin biopsies were obtained for hematoxylin and eosin (H&E) examination, as well as for immunohistochemical (IHC) and direct immunofluorescence (DIF) studies. The H&E review revealed a mild, superficial, perivascular dermal infiltrate of lymphocytes, histiocytes, mast cells and eosinophils. Dermal sclerodermoid alterations were also noted. A mild peripheral blood eosinophilia was found; cutaneous IHC staining revealed staining for anti-HLA-DP, DQ, DR antigen and Complement/C5b-9/MAC, in the areas of the perivascular infiltrate and the sclerodermoid changes. The DIF confirmed these findings. Our case is characterized by a mixed allergic/autoimmune reaction, which did not fit exclusively into any single Gell Coombs immune response category.

Keywords

• Shotgun therapy; Skin rash; Gell coombs classification of allergic reactions