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Okorie CL, Salem I, Scripture AJ, Simmons BJ, Momtahen S, Yan S. Unusual presentations of chronic graft versus host disease. J Cutan Pathol 2024; 51:15-19. [PMID: 37150830 DOI: 10.1111/cup.14444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 04/05/2023] [Accepted: 04/22/2023] [Indexed: 05/09/2023]
Abstract
Skin is commonly affected by graft versus host disease (GVHD), a complication of bone marrow transplantation (BMT). One-third of hematopoietic cell transplantation recipients develop acute eruption classically described as folliculocentric, maculopapular, or morbilliform, in contrast to the more common chronic presentations of sclerotic, poikilodermic, or lichenoid dermatitides. With the wider use of non-myeloablative (reduced-intensity) transplant therapy, various atypical presentations can occur, representing a diagnostic challenge. Herein, we report an unusual case of chronic GVHD manifested by two distinct clinical and histopathological features lacking the classical presentation. Five months after her BMT, the patient presented with a papulosquamous eruption on her neck, trunk, and arms showing a psoriasiform histopathological pattern of chronic GVHD. She also demonstrated multiple small flesh-colored papules on her distal extremities showing a solitary syringotropic pattern of GVHD, demonstrated by interface dermatitis involving the superficial eccrine duct, as the only diagnostic histopathological feature of GVHD. This report, with review of literature, highlights the uncommon psoriasiform GVHD and the novel description of isolated syringotropic chronic GVHD.
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Affiliation(s)
- Chiamaka L Okorie
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
| | - Iman Salem
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Andrew J Scripture
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Brian J Simmons
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shabnam Momtahen
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Shaofeng Yan
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Shakshouk H, Johnson EF, Peters MS, Wieland CN, Comfere NI, Lehman JS. Cutaneous eccrine inflammation and necrosis: review of inflammatory disorders affecting the eccrine apparatus including new associations. Hum Pathol 2021; 118:71-85. [PMID: 34450084 DOI: 10.1016/j.humpath.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
Despite being frequently overlooked during the examination of histopathological sections, eccrine sweat glands can offer clues for diagnosing various skin conditions. They provide important functions and can lead to several diseases when inflamed or injured. This review article provides information regarding eccrine physiology as well as well-established and novel entities that occur in association with eccrine gland pathology.
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Affiliation(s)
- Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Dermatology, Andrology and Venereology, Alexandria University, Alexandria, 21131, Egypt
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Granulysin: killer lymphocyte safeguard against microbes. Curr Opin Immunol 2019; 60:19-29. [PMID: 31112765 DOI: 10.1016/j.coi.2019.04.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/26/2022]
Abstract
Primary T cell immunodeficiency and HIV-infected patients are plagued by non-viral infections caused by bacteria, fungi, and parasites, suggesting an important and underappreciated role for T lymphocytes in controlling microbes. Here, we review recent studies showing that killer lymphocytes use the antimicrobial cytotoxic granule pore-forming peptide granulysin, induced by microbial exposure, to permeabilize cholesterol-poor microbial membranes and deliver death-inducing granzymes into these pathogens. Granulysin and granzymes cause microptosis, programmed cell death in microbes, by inducing reactive oxygen species and destroying microbial antioxidant defenses and disrupting biosynthetic and central metabolism pathways required for their survival, including protein synthesis, glycolysis, and the Krebs cycle.
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Okiyama N, Fujimoto M. Clinical perspectives and murine models of lichenoid tissue reaction/interface dermatitis. J Dermatol Sci 2015; 78:167-72. [PMID: 25813248 DOI: 10.1016/j.jdermsci.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 01/05/2023]
Abstract
A set of histopathological elements, that is death of epidermal basal cell layer keratinocytes and inflammatory cell infiltration, distinguishes lichenoid tissue reaction (LTR)/interface dermatitis (IFD) from other inflammatory mucocutaneous diseases with histological findings of superficial perivascular dermatitis. The LTR/IFD is observed in inflammatory mucocutaneous diseases such as lichen planus, Stevens-Johnson syndrome/toxic epidermal necrolysis, acute graft-versus-host disease, lupus erythematosus and dermatomyositis. Clinical and basic researches have suggested that keratinocytes are antigen-presenting cells and mediate LTR/IFD reaction via production of cytokines/chemokines and inhibitory molecules such as programmed cell death (PD)-L1, and that cytotoxic CD8(+) T cells producing cytotoxic granules, perforin, granzyme B and granulysin are final effector cells to cause keratinocyte death. Because interferon-γ and FasL, which are produced by not only CD8(+) but also CD4(+) T cells, are candidates of the pathogenic molecules in LTR/IFD, CD4(+) T cells may also play a role to develop LTR/IFD. On the other hand, CD4(+) Treg cells accelerate the remission of LTR/IFD. Some murine models of LTR/IFD have been established. For example, LTR/IFD reactions were induced in keratinocyte-specific membrane-binding ovalbumin-transgenic (mOVA Tg) mice by adoptive transfer of CD8(+) T cells with OVA-specific T-cell-receptor. It has also been shown that human CD8(+) T cells are pathogenic immune cells in human skin-xenografted mice. Various immunosuppressants are used to treat patients with mucocutaneous diseases with LTR/IFD. By analysis of the mOVA Tg mice, a JAK inhibitor was suggested to be a new candidate drug to inhibit not only pathogenic T cells but also keratinocyte death in LTR/IFD. More specific treatments for patients with LTR/IFD will be developed in future.
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Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan.
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Ibaraki, Japan
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Ono S, Otsuka A, Yamamoto Y, Kataoka TR, Koyanagi I, Miyachi Y, Kabashima K. Serum granulysin as a possible key marker of the activity of alopecia areata. J Dermatol Sci 2013; 73:74-9. [PMID: 24035442 DOI: 10.1016/j.jdermsci.2013.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alopecia areata (AA) is an organ-restricted autoimmune condition of the hair follicles (HFs) that presents as nonscarring hair loss. A collapse of immunoprivilege for cell-mediated cytotoxicity and following attacks by cytotoxic T cells to anagen HFs are considered to play a major role in the pathogenesis of AA. However, there has been no useful marker for the activity of AA to date. OBJECTIVE The aim of this study is to examine whether granulysin, which is known to reflect the activity of cytotoxic immune responses, is related to the disease activity of AA. METHODS We evaluated serum granulysin levels in acute and chronic AA patients compared to healthy controls in the perspective of bald skin areas, prognosis, and co-existence of other allergic diseases. In addition, immunohistochemical analysis for granulysin-, CD4-, CD8-, and CD56-positive cells in the lesional skin of acute and chronic AA patients was performed. RESULTS Serum granulysin levels were significantly elevated in both acute and chronic AA patients (p=0.00081 and p=0.0012, respectively). Intriguingly, serum granulysin levels were significantly associated with the broader bald skin areas (Spearman's r=0.59, p=0.017), and poorer prognosis in acute AA patients (p=0.0080). They were also associated with co-existence of allergic disorders in AA patients (p=0.026). Immunohistochemical staining demonstrated that perifollicular granulysin-bearing cells were mainly detected in acute AA lesions with dense lymphocytic infiltration, and that these granulysin-bearing cells were consistent with CD8(+) T cells. CONCLUSION The serum granulysin level may be a useful and novel marker for the disease activity in the acute phase of AA.
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Affiliation(s)
- Sachiko Ono
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Atsushi Otsuka
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuki R Kataoka
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Itsuko Koyanagi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Miyachi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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