Investigating the histopathological findings and immunolocalization of rickettsialpox infection in skin biopsies: A case series and review of the literature.

Autor: Vyas NS; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York., Shieh WJ; Infectious Diseases Pathology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia., Phelps RG; Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
Jazyk: angličtina
Zdroj: Journal of cutaneous pathology [J Cutan Pathol] 2020 May; Vol. 47 (5), pp. 451-458. Date of Electronic Publication: 2020 Feb 03.
DOI: 10.1111/cup.13649
Abstrakt: Background: Recognition of rickettsialpox infection on skin biopsy can be challenging. The histopathology is non-specific and inconsistently described. We assess classic histopathologic features in confirmed cases and review the literature.
Methods: We searched for cases of "rickettsialpox" diagnosed between 2006 and 2018 with positive immunostaining for Spotted Fever Group Rickettsia species. Original slides were evaluated for vacuolar alterations, granulomatous inflammation, vasculitis, necrosis, fibrin thrombi, microvesiculation, papillary dermal edema, and extravasated red blood cells. All biopsies were stained for CD3, CD20, CD68, and myeloperoxidase.
Results: Six biopsy specimens were compiled, three of which were sampled from vesiculopapules, one from a maculopapule, and two from eschars. Vacuolar alterations and vasculitis were present in all specimens (6/6; 100%). Granulomatous inflammation was present in five specimens (5/6; 83.3%). Fibrin thrombi and red blood cells were seen in 3/6 (50%) of specimens. The eschars showed necrosis of the epidermis and superficial dermis (2/6, 33.3%). Only one specimen showed intraepidermal vesiculation and papillary dermal edema (1/6; 16.7%). All six specimens showed perivascular infiltration with CD3+ T-cells, and low amounts of CD20+ B-cells and neutrophils. Five of the six specimens (83.3%) showed significant levels of CD68+ histiocytes.
Conclusion: The histopathology of rickettsialpox infection is septic lymphocytic and granulomatous vasculitis.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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