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<p>Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening mucocutaneous conditions traditionally regarded as severe T cell–mediated hypersensitivity reactions. However, recent evidence has highlighted the potential role of myeloperoxidase (MPO), primarily produced by neutrophils, in the pathogenesis of SJS/TEN. Here, we examined the expression of MPO in skin biopsy specimens from patients with SJS/TEN (<i>n</i> = 15) to evaluate its diagnostic utility, comparing the findings with those from patients with erythema multiforme (EM) (<i>n</i> = 8) and graft-versus-host disease (GVHD) (<i>n</i> = 10). MPO-positive mononuclear cells were present in all SJS/TEN cases, often outnumbering CD3-positive T cells (86.7%). A significantly higher number of cases with an MPO/CD3 ratio greater than 1 was observed in patients with SJS/TEN compared with that in patients with GVHD (<i>p</i> &lt; 0.01). However, no such difference was observed between SJS/TEN and EM. These findings suggest that an MPO/CD3 &gt; 1 is a pathologic feature of SJS/TEN; however, its specificity may be limited.</p>

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Myeloperoxidase-positive mononuclear cells predominate over CD3-positive T-lymphocytes in the epidermis of Stevens–Johnson syndrome and toxic epidermal necrolysis

  • 期刊论文

  • 发表日期：

    2025年10月8日

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  • Masakazu Fujimoto,
  • Yuki Teramoto,
  • Kai Mizoguchi,
  • Kodai Furuta,
  • Hiroyuki Irie,
  • Yo Kaku,
  • Masahiro Hirata,
  • Kenji Kabashima,
  • Hironori Haga

摘要

Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening mucocutaneous conditions traditionally regarded as severe T cell–mediated hypersensitivity reactions. However, recent evidence has highlighted the potential role of myeloperoxidase (MPO), primarily produced by neutrophils, in the pathogenesis of SJS/TEN. Here, we examined the expression of MPO in skin biopsy specimens from patients with SJS/TEN (n = 15) to evaluate its diagnostic utility, comparing the findings with those from patients with erythema multiforme (EM) (n = 8) and graft-versus-host disease (GVHD) (n = 10). MPO-positive mononuclear cells were present in all SJS/TEN cases, often outnumbering CD3-positive T cells (86.7%). A significantly higher number of cases with an MPO/CD3 ratio greater than 1 was observed in patients with SJS/TEN compared with that in patients with GVHD (p < 0.01). However, no such difference was observed between SJS/TEN and EM. These findings suggest that an MPO/CD3 > 1 is a pathologic feature of SJS/TEN; however, its specificity may be limited.