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Specific Mucosal Erosions in Hypereosinophilic Syndrome: Evidence for Eosinophil Protein Deposition

Specific Mucosal Erosions in Hypereosinophilic Syndrome: Evidence for Eosinophil Protein Deposition Abstract Background: Mucosal erosions can be a presenting feature of the hypereosinophilic syndrome. The aim of this study was to analyze in situ the presence of eosinophil proteins and the state of eosinophil activation. Biopsy specimens of mucosal lesions and normal skin were taken from two men with oral and genital erosions typical of hypereosinophilic syndrome. Tissue sections were immunohistochemically labeled with anti-major basic protein, anti—eosinophil-derived neurotoxin, and anti—eosinophil peroxidase antibodies. The same specimens were also subjected to electron microscope examination. Observations: Eroded specimens displayed areas of eosinophil spongiosis within which extracellular deposits of eosinophil peroxidase, major basic protein, and eosinophil-derived neurotoxin were present. In normal skin, only a few eosinophils were present within the capillary lumen, and no extracellular deposits of these proteins were seen. Under the electron microscope, the cytoplasmic membranes of eosinophils located around the erosion were disrupted. Remnants of necrotic keratinocytes were found near these lysed eosinophils. Conclusion: As with other involved organs in hypereosinophilic syndrome, mucosal erosions seem to be the consequence of eosinophil protein release.(Arch Dermatol. 1996;132:535-541) References 1. Leiferman KM, O'Duffy D, Perry HO, Greipp PR, Giuliani ER, Gleich GR. Recurrent incapacitating mucosal ulcerations: a prodrome of the hypereosinophilic syndrome . Am J Med. 1982;247:1018-1020. 2. Leiferman KM, Gleich GR. Cutaneous eosinophilic diseases . In: Fitzpatrick TB, ed. Dermatology in General Medicine . New York, NY: McGraw-Hill International Book Co; 1993:1156-1164. 3. Prin L, Capron M, Tonnel AB, Blétry O, Capron A. Heterogeneity of human blood eosinophils: variability in cell density and cytotoxic ability in relation to the level and the origin of hypereosinophilia . Int Arch Allergy Appl Immunol. 1983;72:336-346.Crossref 4. Bernard P. Prost C, Lecerf V, et al. Studies of cicatricial pemphigoid autoantibodies using direct immunoelectron microscopic and immunoblot analysis . J Invest Dermatol. 1990;94:630-635.Crossref 5. Deviller P, Gruart V, Prin L, Bulle C, Capron M, Cordier JF. Detection of an eosinophil-derived neurotoxin in the urine of a patient with idiopathic chronic eosinophilic pneumonia . Clin Chim Acta. 1991;201:105-112.Crossref 6. Graham RC, Karnovsky MJ. Early stage of absorption of injected horseradish peroxidase in the proximal tubule of mouse kidney: ultrastructural cytochemistry by a new technique . J Histochem Cytochem. 1966;14:291-302.Crossref 7. Hardy HR, Anderson RE. The hypereosinophilic syndrome . Ann Intern Med. 1968;68:1220-1228.Crossref 8. Chusid MJ, Dale CD, West BC, Wolff SM. The hypereosinophilic syndrome . Medicine. 1975;54:1-27.Crossref 9. Kasmierowski JA, Chusid MJ, Parillo JE, Fauci AS, Wolff SA. Dermatologic manifestations of hypereosinophilic syndrome . Arch Dermatol. 1978;114:531-535.Crossref 10. Bentley HP, Reardon AE, Knoedler JP. Eosinophilic leukemia . Am J Med. 1961; 30:310-322.Crossref 11. Benvenisti DS, Utman JE. Eosinophilic leukemia . Ann Intern Med. 1969;71: 731-745.Crossref 12. Brugger F, Treuner J, Undeutsch W. Hypereosinophilie syndröm mit dermaler exanthematischer vesikulobulloser manifestation . Z Hautkr. 1980;55:855-867. 13. Parker CJ. Hypereosinophilic syndrome with cutaneous blisters and bowel necrosis . Australas J Dermatol. 1988;29:103-106.Crossref 14. Evans TS, Nesbit RR. Eosinophilic leukemia . Blood. 1949;4:603-613. 15. Brogadir SP, Goldwein MI, Schumacher HR. A hypereosinophilic syndrome mimicking rheumatoid arthritis . Am J Med. 1980;69:799-802.Crossref 16. Lee ML, Fischer G, Gow E. Hypereosinophilic syndrome presenting with erythroderma . Australas J Dermatol. 1988;29:95-101.Crossref 17. May LP, Kelly J, Sanchez M. Hypereosinophilic syndrome with unusual cutaneous manifestations in two men with HIV infection . J Am Acad Dermatol. 1990;23:202-204.Crossref 18. Shelley WB, Shelley ED. Erythema annulare centrifugum as the presenting sign of the hypereosinophilic syndrome . Cutis. 1985;35:53-58. 19. Newton JA, Singh AK, Greaves MW. Aquagenic pruritus associated with the hypereosinophilic syndrome . Br J Dermatol. 1990;122:103-106.Crossref 20. Dereure O, Meyer F, Ciurana AJ, Guilhou JJ. Dermatological manifestations of idiopathic hypereosinophilic syndrome: an unusual observation with protracted course and literature review . Eur J Dermatol. 1994;4:110-116. 21. Gleich GJ, Schroeter AL, Marcoux P, Sachs MI, O'Connell EJ, Kohler PF. Episodic angioedema associated with eosinophilia . N Engl J Med. 1984:310:1621-1626.Crossref 22. Chen K-R, Pittelkow MR, Su WPD, Gleich GJ, Newman W, Leiferman KM. Recurrent cutaneous necrotizing vasculitis: a novel eosinophil-mediated syndrome . Arch Dermatol. 1994;130:1159-1166.Crossref 23. Lamotte Barillon S. Carbon C, Bernard JF, Gaudin H, Teillet F, Barge J. Leucémie à éosinophiles et coagulation intravasculaire disséminée Sem Hop Paris. 1976;16:987-998. 24. Foasso MF, Hermier M, Mermillon M, François R. Le syndrome hyperéosinophilique avec atteinte endomyocardique chez l'enfant . Pediatrie. 1984;39:147-155. 25. Elnékavé FL, Calvo F, Erner J, Vérola O, Morel P, Puissant A. Manifestations cutanées d'un syndrome hyperéosinophilique . Ann Dermatol Venereol. 1986; 113:961-965. 26. Alfaham MA, Ferguson SD, Sihra B. The idiopathic hypereosinophilic syndrome . Arch Dis Child. 1987;62:601-613.Crossref 27. Akahoshi M, Hoshino S, Teramura M, Oshimi K, Mizoguchi H, Hidano A. Recurrent oral and genital ulcers as the prodrome of the hypereosinophilic syndrome: report of a probable cause . Nippon Naika Gakkai Zasshi. 1987;76:421-424.Crossref 28. Prin L, Blétry O, Tonnel A, et al. Lesions viscerales des syndromes hypereosinophiliques . Presse Med. 1987;16:945-949. 29. Smit AJ, van Essen LH, de Vries EG. Successful long term control of idiopathic hypereosinophilic syndrome with etoposide . Cancer. 1991;67:2826-2827.Crossref 30. Sanchez JL, Padilla MA. Hypereosinophlic syndrome . Cutis. 1982;29:490-493. 31. Tai PC, Ackerman SJ, Spry CJF, Dunnette S, Olsen EGJ, Gleich GJ. Deposits of eosinophil granule proteins in cardiac tissue of patients with eosinophilic endomyocardial disease . Lancet. 1987;1:643-647.Crossref 32. Desremeaux P, Janin A, Dubucquoi S, et al. Synthesis of IL5 by activated eosinophils in patients with eosinophilic heart disease . Blood. 1993;5:1553-1560. 33. Prin L, Plumas J, Gruart V, et al. Elevated serum levels of soluble IL2 receptor: a marker of disease activity in the hypereosinophilic syndrome . Blood. 1991;78:2626-2632. 34. Weller PF. The immunobiology of eosinophils . N Engl J Med. 1991;324:1110-1118.Crossref 35. Liesveld JL, Abboud CN. State of the art: the hypereosinophilic syndromes . Blood Rev. 1991;5:29-37.Crossref 36. Capron M. Eosinophils: receptors and mediators in hypersensitivity . Clin Exp Allergy. 1989;19:3-8. 37. Butterfield JH, Gleich GJ. Interferon a treatment of six patients with idiopathic hypereosinophilic syndrome . Ann Intern Med. 1994;121:648-653.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Specific Mucosal Erosions in Hypereosinophilic Syndrome: Evidence for Eosinophil Protein Deposition

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890290069009
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Abstract

Abstract Background: Mucosal erosions can be a presenting feature of the hypereosinophilic syndrome. The aim of this study was to analyze in situ the presence of eosinophil proteins and the state of eosinophil activation. Biopsy specimens of mucosal lesions and normal skin were taken from two men with oral and genital erosions typical of hypereosinophilic syndrome. Tissue sections were immunohistochemically labeled with anti-major basic protein, anti—eosinophil-derived neurotoxin, and anti—eosinophil peroxidase antibodies. The same specimens were also subjected to electron microscope examination. Observations: Eroded specimens displayed areas of eosinophil spongiosis within which extracellular deposits of eosinophil peroxidase, major basic protein, and eosinophil-derived neurotoxin were present. In normal skin, only a few eosinophils were present within the capillary lumen, and no extracellular deposits of these proteins were seen. Under the electron microscope, the cytoplasmic membranes of eosinophils located around the erosion were disrupted. Remnants of necrotic keratinocytes were found near these lysed eosinophils. Conclusion: As with other involved organs in hypereosinophilic syndrome, mucosal erosions seem to be the consequence of eosinophil protein release.(Arch Dermatol. 1996;132:535-541) References 1. Leiferman KM, O'Duffy D, Perry HO, Greipp PR, Giuliani ER, Gleich GR. Recurrent incapacitating mucosal ulcerations: a prodrome of the hypereosinophilic syndrome . Am J Med. 1982;247:1018-1020. 2. Leiferman KM, Gleich GR. Cutaneous eosinophilic diseases . In: Fitzpatrick TB, ed. Dermatology in General Medicine . New York, NY: McGraw-Hill International Book Co; 1993:1156-1164. 3. Prin L, Capron M, Tonnel AB, Blétry O, Capron A. Heterogeneity of human blood eosinophils: variability in cell density and cytotoxic ability in relation to the level and the origin of hypereosinophilia . Int Arch Allergy Appl Immunol. 1983;72:336-346.Crossref 4. Bernard P. Prost C, Lecerf V, et al. Studies of cicatricial pemphigoid autoantibodies using direct immunoelectron microscopic and immunoblot analysis . J Invest Dermatol. 1990;94:630-635.Crossref 5. Deviller P, Gruart V, Prin L, Bulle C, Capron M, Cordier JF. Detection of an eosinophil-derived neurotoxin in the urine of a patient with idiopathic chronic eosinophilic pneumonia . Clin Chim Acta. 1991;201:105-112.Crossref 6. Graham RC, Karnovsky MJ. Early stage of absorption of injected horseradish peroxidase in the proximal tubule of mouse kidney: ultrastructural cytochemistry by a new technique . J Histochem Cytochem. 1966;14:291-302.Crossref 7. Hardy HR, Anderson RE. The hypereosinophilic syndrome . Ann Intern Med. 1968;68:1220-1228.Crossref 8. Chusid MJ, Dale CD, West BC, Wolff SM. The hypereosinophilic syndrome . Medicine. 1975;54:1-27.Crossref 9. Kasmierowski JA, Chusid MJ, Parillo JE, Fauci AS, Wolff SA. Dermatologic manifestations of hypereosinophilic syndrome . Arch Dermatol. 1978;114:531-535.Crossref 10. Bentley HP, Reardon AE, Knoedler JP. Eosinophilic leukemia . Am J Med. 1961; 30:310-322.Crossref 11. Benvenisti DS, Utman JE. Eosinophilic leukemia . Ann Intern Med. 1969;71: 731-745.Crossref 12. Brugger F, Treuner J, Undeutsch W. Hypereosinophilie syndröm mit dermaler exanthematischer vesikulobulloser manifestation . Z Hautkr. 1980;55:855-867. 13. Parker CJ. Hypereosinophilic syndrome with cutaneous blisters and bowel necrosis . Australas J Dermatol. 1988;29:103-106.Crossref 14. Evans TS, Nesbit RR. Eosinophilic leukemia . Blood. 1949;4:603-613. 15. Brogadir SP, Goldwein MI, Schumacher HR. A hypereosinophilic syndrome mimicking rheumatoid arthritis . Am J Med. 1980;69:799-802.Crossref 16. Lee ML, Fischer G, Gow E. Hypereosinophilic syndrome presenting with erythroderma . Australas J Dermatol. 1988;29:95-101.Crossref 17. May LP, Kelly J, Sanchez M. Hypereosinophilic syndrome with unusual cutaneous manifestations in two men with HIV infection . J Am Acad Dermatol. 1990;23:202-204.Crossref 18. Shelley WB, Shelley ED. Erythema annulare centrifugum as the presenting sign of the hypereosinophilic syndrome . Cutis. 1985;35:53-58. 19. Newton JA, Singh AK, Greaves MW. Aquagenic pruritus associated with the hypereosinophilic syndrome . Br J Dermatol. 1990;122:103-106.Crossref 20. Dereure O, Meyer F, Ciurana AJ, Guilhou JJ. Dermatological manifestations of idiopathic hypereosinophilic syndrome: an unusual observation with protracted course and literature review . Eur J Dermatol. 1994;4:110-116. 21. Gleich GJ, Schroeter AL, Marcoux P, Sachs MI, O'Connell EJ, Kohler PF. Episodic angioedema associated with eosinophilia . N Engl J Med. 1984:310:1621-1626.Crossref 22. Chen K-R, Pittelkow MR, Su WPD, Gleich GJ, Newman W, Leiferman KM. Recurrent cutaneous necrotizing vasculitis: a novel eosinophil-mediated syndrome . Arch Dermatol. 1994;130:1159-1166.Crossref 23. Lamotte Barillon S. Carbon C, Bernard JF, Gaudin H, Teillet F, Barge J. Leucémie à éosinophiles et coagulation intravasculaire disséminée Sem Hop Paris. 1976;16:987-998. 24. Foasso MF, Hermier M, Mermillon M, François R. Le syndrome hyperéosinophilique avec atteinte endomyocardique chez l'enfant . Pediatrie. 1984;39:147-155. 25. Elnékavé FL, Calvo F, Erner J, Vérola O, Morel P, Puissant A. Manifestations cutanées d'un syndrome hyperéosinophilique . Ann Dermatol Venereol. 1986; 113:961-965. 26. Alfaham MA, Ferguson SD, Sihra B. The idiopathic hypereosinophilic syndrome . Arch Dis Child. 1987;62:601-613.Crossref 27. Akahoshi M, Hoshino S, Teramura M, Oshimi K, Mizoguchi H, Hidano A. Recurrent oral and genital ulcers as the prodrome of the hypereosinophilic syndrome: report of a probable cause . Nippon Naika Gakkai Zasshi. 1987;76:421-424.Crossref 28. Prin L, Blétry O, Tonnel A, et al. Lesions viscerales des syndromes hypereosinophiliques . Presse Med. 1987;16:945-949. 29. Smit AJ, van Essen LH, de Vries EG. Successful long term control of idiopathic hypereosinophilic syndrome with etoposide . Cancer. 1991;67:2826-2827.Crossref 30. Sanchez JL, Padilla MA. Hypereosinophlic syndrome . Cutis. 1982;29:490-493. 31. Tai PC, Ackerman SJ, Spry CJF, Dunnette S, Olsen EGJ, Gleich GJ. Deposits of eosinophil granule proteins in cardiac tissue of patients with eosinophilic endomyocardial disease . Lancet. 1987;1:643-647.Crossref 32. Desremeaux P, Janin A, Dubucquoi S, et al. Synthesis of IL5 by activated eosinophils in patients with eosinophilic heart disease . Blood. 1993;5:1553-1560. 33. Prin L, Plumas J, Gruart V, et al. Elevated serum levels of soluble IL2 receptor: a marker of disease activity in the hypereosinophilic syndrome . Blood. 1991;78:2626-2632. 34. Weller PF. The immunobiology of eosinophils . N Engl J Med. 1991;324:1110-1118.Crossref 35. Liesveld JL, Abboud CN. State of the art: the hypereosinophilic syndromes . Blood Rev. 1991;5:29-37.Crossref 36. Capron M. Eosinophils: receptors and mediators in hypersensitivity . Clin Exp Allergy. 1989;19:3-8. 37. Butterfield JH, Gleich GJ. Interferon a treatment of six patients with idiopathic hypereosinophilic syndrome . Ann Intern Med. 1994;121:648-653.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: May 1, 1996

References