b) El examen histológico revela una dermatitis de interfase, caracterizada por acumulación predominante de linfocitos en la zona de unión dermoepidérmica junto con alteración vacuolar de los queratinocitos (flecha) en la capa basal (corte teñido con HE). c) Además, se observan queratinocitos disqueratósicos aislados (flecha). d) Las células T que contienen proteínas citotóxicas como granzima B (coloreada en rojo) están considerablemente aumentadas a lo largo de la zona de unión dermoepidérmica o en la epidermis (método del complejo de avidina-biotina/fosfatasa alcalina). Bibliografía1. Pichler WJ, Yawalkar N. Allergic reactions to drugs: involvement of T cells. Thorax 2000; 55 (Suppl 2):S61--S65.2. Gonzalez FJ, Leyva L, Posadas S, et al. Participation of T lymphocytes in cutaneous allergic reactions to drugs. Clin Exp Allergy 1998; 28 (Suppl 4):3--6.3. Merk HF, Hertl M. Immunologic mechanisms of cutaneous drug reactions. Semin Cutan Med Surg 1996; 15:228--235.4. Yawalkar N, Egli F, Hari Y, Nievergelt H, Braathen LR, Pichler WJ. Infiltration of cytotoxic T cells in drug-induced cutaneous eruptions. Clin Exp Allergy 2000; 30:847--855.5. Carr A, Vasak E, Munro V, et al. Immunohistological assessment of cutaneous drug hypersensitivity in patients with HIV infection. Clin Exp Immunol 1994; 97:260--265.6. Schnyder B, Frutig K, Mauri-Hellweg D, Limat A, Yawalkar N, Pichler WJ. T-cell-mediated cytotoxicity against keratinocytes in sulfamethoxazole- induced skin reaction. Clin Exp Allergy 1998; 28:1412-14177 Pichler WJ, Zanni M, von Greyerz S, Schnyder B, Mauri-Hellweg D, Wendland T.High IL-5 production by human drug-specific T cell clones. Int Arch Allergy Immunol 1997; 113:177--180.8. Zanni MP, Mauri-Hellweg D, Brander C, Wendland T, Schnyder B, Frei E, von Greyerz S, Bircher A, Pichler WJ. Characterization of lidocaine-specific T cells. J Immunol 1997; 158:1139--1148.9. Brander C, Mauri-Hellweg D, Bettens F, Rolli H, Goldman M, Pichler WJ. Heterogeneous T cell responses to beta-lactam-modified self-structures are observed in penicillin-allergic individuals. J Immunol 1995; 55:2670--2678.10. Posadas SJ, Leyva L, Torres MJ, Leyva L, Mayorga C, Gonzalez L, Juarez C, Fernandez J, Santamaria LF. Subjects with allergic reactions to drugs show in vivo polarized patterns of cytokine expression depending on the chronology of the clinical reaction. J Allergy Clin Immunol 2000; 106:769--776.11. Yawalkar N, Shrikhande M, Hari Y, Nievergelt H, Braathen LR, J. Pichler W. Evidence for a role for IL-5 and eotaxin in activating and recruiting eosinophils in drug-induced cutaneous eruptions. J Allergy Clin Immunol 2000; 106:1171--1176.12. Britschgi M, Steiner U, Schmid S, Bircher A, Burkhart C, Yawalkar N, Pichler J. Immunological characterization of four patients with drug-induced acute generalized exanthematous pustulosis. J Clin Invest 2001; 107:1433-144113. Schnyder B, Mauri-Hellweg D, Zanni M, Bettens F, Pichler WJ. Direct, MHC-dependent presentation of the drug sulfamethoxazole to human T cell clones. J Clin Invest 1997; 100:136--141.14. Zanni MP, von Greyerz S, Schnyder B, Brander KA, Frutig K, Hari Y, Valitutti S, Pichler WJ. HLA-restricted, processing- and metabolism-independent pathway of drug recognition by human T lymphocytes. J Clin Invest 1998; 102:1591--1598.15. Hertl M, Bohlen H, Jugert F, Boecker C, Knaup R, Merk HF. Predominance of epidermal CD8+ T lymphocytes in bullous cutaneous reactions caused by beta-lactam antibiotics. J Invest Dermatol 1993; 101:794--799.16. Hertl M, Jugert F, Merk HF. CD8+ dermal T cells from a sulphamethoxazole-induced bullous exanthem proliferate in response to drug-modified liver microsomes. Br J Dermatol 1995; 132:215--220.
teñido con HE). c) Además, se observan queratinocitos disqueratósicos aislados (flecha). d) Las células T que contienen proteínas citotóxicas como granzima B (coloreada en rojo) están considerablemente aumentadas a lo largo de la zona de unión dermoepidérmica o en la epidermis (método del complejo de avidina-biotina/fosfatasa alcalina). Bibliografía1. Pichler WJ, Yawalkar N. Allergic reactions to drugs: involvement of T cells. Thorax 2000; 55 (Suppl 2):S61--S65.2. Gonzalez FJ, Leyva L, Posadas S, et al. Participation of T lymphocytes in cutaneous allergic reactions to drugs. Clin Exp Allergy 1998; 28 (Suppl 4):3--6.3. Merk HF, Hertl M. Immunologic mechanisms of cutaneous drug reactions. Semin Cutan Med Surg 1996; 15:228--235.4. Yawalkar N, Egli F, Hari Y, Nievergelt H, Braathen LR, Pichler WJ. Infiltration of cytotoxic T cells in drug-induced cutaneous eruptions. Clin Exp Allergy 2000; 30:847--855.5. Carr A, Vasak E, Munro V, et al. Immunohistological assessment of cutaneous drug hypersensitivity in patients with HIV infection. Clin Exp Immunol 1994; 97:260--265.6. Schnyder B, Frutig K, Mauri-Hellweg D, Limat A, Yawalkar N, Pichler WJ. T-cell-mediated cytotoxicity against keratinocytes in sulfamethoxazole- induced skin reaction. Clin Exp Allergy 1998; 28:1412-14177 Pichler WJ, Zanni M, von Greyerz S, Schnyder B, Mauri-Hellweg D, Wendland T.High IL-5 production by human drug-specific T cell clones. Int Arch Allergy Immunol 1997; 113:177--180.8. Zanni MP, Mauri-Hellweg D, Brander C, Wendland T, Schnyder B, Frei E, von Greyerz S, Bircher A, Pichler WJ. Characterization of lidocaine-specific T cells. J Immunol 1997; 158:1139--1148.9. Brander C, Mauri-Hellweg D, Bettens F, Rolli H, Goldman M, Pichler WJ. Heterogeneous T cell responses to beta-lactam-modified self-structures are observed in penicillin-allergic individuals. J Immunol 1995; 55:2670--2678.10. Posadas SJ, Leyva L, Torres MJ, Leyva L, Mayorga C, Gonzalez L, Juarez C, Fernandez J, Santamaria LF. Subjects with allergic reactions to drugs show in vivo polarized patterns of cytokine expression depending on the chronology of the clinical reaction. J Allergy Clin Immunol 2000; 106:769--776.11. Yawalkar N, Shrikhande M, Hari Y, Nievergelt H, Braathen LR, J. Pichler W. Evidence for a role for IL-5 and eotaxin in activating and recruiting eosinophils in drug-induced cutaneous eruptions. J Allergy Clin Immunol 2000; 106:1171--1176.12. Britschgi M, Steiner U, Schmid S, Bircher A, Burkhart C, Yawalkar N, Pichler J. Immunological characterization of four patients with drug-induced acute generalized exanthematous pustulosis. J Clin Invest 2001; 107:1433-144113. Schnyder B, Mauri-Hellweg D, Zanni M, Bettens F, Pichler WJ. Direct, MHC-dependent presentation of the drug sulfamethoxazole to human T cell clones. J Clin Invest 1997; 100:136--141.14. Zanni MP, von Greyerz S, Schnyder B, Brander KA, Frutig K, Hari Y, Valitutti S, Pichler WJ. HLA-restricted, processing- and metabolism-independent pathway of drug recognition by human T lymphocytes. J Clin Invest 1998; 102:1591--1598.15. Hertl M, Bohlen H, Jugert F, Boecker C, Knaup R, Merk HF. Predominance of epidermal CD8+ T lymphocytes in bullous cutaneous reactions caused by beta-lactam antibiotics. J Invest Dermatol 1993; 101:794--799.16. Hertl M, Jugert F, Merk HF. CD8+ dermal T cells from a sulphamethoxazole-induced bullous exanthem proliferate in response to drug-modified liver microsomes. Br J Dermatol 1995; 132:215--220.
(flecha). d) Las células T que contienen proteínas citotóxicas como granzima B (coloreada en rojo) están considerablemente aumentadas a lo largo de la zona de unión dermoepidérmica o en la epidermis (método del complejo de avidina-biotina/fosfatasa alcalina). Bibliografía1. Pichler WJ, Yawalkar N. Allergic reactions to drugs: involvement of T cells. Thorax 2000; 55 (Suppl 2):S61--S65.2. Gonzalez FJ, Leyva L, Posadas S, et al. Participation of T lymphocytes in cutaneous allergic reactions to drugs. Clin Exp Allergy 1998; 28 (Suppl 4):3--6.3. Merk HF, Hertl M. Immunologic mechanisms of cutaneous drug reactions. Semin Cutan Med Surg 1996; 15:228--235.4. Yawalkar N, Egli F, Hari Y, Nievergelt H, Braathen LR, Pichler WJ. Infiltration of cytotoxic T cells in drug-induced cutaneous eruptions. Clin Exp Allergy 2000; 30:847--855.5. Carr A, Vasak E, Munro V, et al. Immunohistological assessment of cutaneous drug hypersensitivity in patients with HIV infection. Clin Exp Immunol 1994; 97:260--265.6. Schnyder B, Frutig K, Mauri-Hellweg D, Limat A, Yawalkar N, Pichler WJ. T-cell-mediated cytotoxicity against keratinocytes in sulfamethoxazole- induced skin reaction. Clin Exp Allergy 1998; 28:1412-14177 Pichler WJ, Zanni M, von Greyerz S, Schnyder B, Mauri-Hellweg D, Wendland T.High IL-5 production by human drug-specific T cell clones. Int Arch Allergy Immunol 1997; 113:177--180.8. Zanni MP, Mauri-Hellweg D, Brander C, Wendland T, Schnyder B, Frei E, von Greyerz S, Bircher A, Pichler WJ. Characterization of lidocaine-specific T cells. J Immunol 1997; 158:1139--1148.9. Brander C, Mauri-Hellweg D, Bettens F, Rolli H, Goldman M, Pichler WJ. Heterogeneous T cell responses to beta-lactam-modified self-structures are observed in penicillin-allergic individuals. J Immunol 1995; 55:2670--2678.10. Posadas SJ, Leyva L, Torres MJ, Leyva L, Mayorga C, Gonzalez L, Juarez C, Fernandez J, Santamaria LF. Subjects with allergic reactions to drugs show in vivo polarized patterns of cytokine expression depending on the chronology of the clinical reaction. J Allergy Clin Immunol 2000; 106:769--776.11. Yawalkar N, Shrikhande M, Hari Y, Nievergelt H, Braathen LR, J. Pichler W. Evidence for a role for IL-5 and eotaxin in activating and recruiting eosinophils in drug-induced cutaneous eruptions. J Allergy Clin Immunol 2000; 106:1171--1176.12. Britschgi M, Steiner U, Schmid S, Bircher A, Burkhart C, Yawalkar N, Pichler J. Immunological characterization of four patients with drug-induced acute generalized exanthematous pustulosis. J Clin Invest 2001; 107:1433-144113. Schnyder B, Mauri-Hellweg D, Zanni M, Bettens F, Pichler WJ. Direct, MHC-dependent presentation of the drug sulfamethoxazole to human T cell clones. J Clin Invest 1997; 100:136--141.14. Zanni MP, von Greyerz S, Schnyder B, Brander KA, Frutig K, Hari Y, Valitutti S, Pichler WJ. HLA-restricted, processing- and metabolism-independent pathway of drug recognition by human T lymphocytes. J Clin Invest 1998; 102:1591--1598.15. Hertl M, Bohlen H, Jugert F, Boecker C, Knaup R, Merk HF. Predominance of epidermal CD8+ T lymphocytes in bullous cutaneous reactions caused by beta-lactam antibiotics. J Invest Dermatol 1993; 101:794--799.16. Hertl M, Jugert F, Merk HF. CD8+ dermal T cells from a sulphamethoxazole-induced bullous exanthem proliferate in response to drug-modified liver microsomes. Br J Dermatol 1995; 132:215--220.

La respuesta correcta se infiere al leer atentamente el trabajo:

EL PAPEL DE LAS CELULAS T CITOTOXICAS EN EL EXANTEMA MACULOPAPULAR INDUCIDO POR DROGAS

Programa SIIC  de Eduación Médica Contínua (PEMC-SIIC)