Thread by @SibaElHussein

(1/6) Future #dermpath star, @DermpatGal, & I have put together an illustration of hematologic findings in "Drug Reaction with Eosinophilia & Systemic Symptoms" (DRESS) @AjHematology ➡️ bit.ly/3u9WvLa

#hemepath #pathtwitter @Pathology_URMC 🔬

#Tweetorial ⬇️

(2/6) Drug metabolites (commonly of anti-anticonvulsant medication) are thought to stimulate T-cells leading to a florid immune response/ or cause viral activation (HHV6) leading to downstream immune activation

(Pathogenesis of DRESS➡️bit.ly/3F3uKJp @MDPIOpenAccess )

(3/6) In the setting of DRESS, peripheral blood smears show prominent eosinophilia with many degranulated forms

(4/6) Atypical lymphocytosis characterized by large lymphocytes, deeply basophilic cytoplasm, irregular nuclear contours, clumped chromatin and
conspicuous nucleoli

(5/6) and increased monocytes demonstrating immature features (hypolobated nuclei and prominent nucleoli)

(6/6) Key teaching point: Awareness of these peripheral blood findings: Morphologically atypical eosinophilia, lymphocytosis and monocytosis due to florid immune activation in the setting of DRESS, is key not confuse it for an underlying hematologic neoplastic process #hemepath