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. 2021 Mar 4;11:621591. doi: 10.3389/fonc.2021.621591

Figure 4.

Figure 4

Clinicopathologic illustration of Patient 2. (A) Crusted thin red papules on the chest. (B) Patient 2 skin biopsy with interface dermatitis toxicity (lesion 1) with scattered dyskeratotic cells and the superficial perivascular dermal inflammatory infiltrate with eosinophils (hematoxylin and eosin, original magnification, 40x). (C, D) Immunohistochemical studies show that the inflammatory infiltrates are composed of CD4+ T-cells with a subset of CD8+ T-cells (Immunohistochemistry, anti-CD4 and anti-CD8, x400). (E, F) Multiplex immunofluorescence (mIF) studies with immune-oncology toxicity panel of anti-CD3, anti-CD8, anti-FoxP3, anti-TBet, anti-Gata3, and anti-RORγT antibodies. Patient 2, interface dermatitis toxicity (lesion 1) shows dermal inflammatory infiltrate that exhibits Th2 immunophenotype with Gata3+ cells (pink). There is a subset of Tregs, Foxp3+ cells (cyan), and Th17, RORγT positive cells (green) in the inflammatory infiltrate. (G) Erythematous patches on the abdomen. (H) Patient 2 skin biopsy with bullous toxicity (lesion 2) with scattered dyskeratotic cells (white arrows) and the superficial perivascular dermal inflammatory infiltrate with eosinophils and few neutrophils [hematoxylin and eosin (H&E), original magnification]. (I, J) Immunohistochemical studies show that the inflammatory infiltrates are composed of CD4+ T-cells with a subset of CD8+ T-cells (immunohistochemistry, anti-CD4 and anti-CD8, x400). (K, L) Multiplex immunofluorescence (mIF) studies with immune-oncology toxicity panel for patient 2; bullous toxicity (lesion 2) shows similar Th2 immunophenotype with Gata3+ cells (pink) and subsets of Tregs, Foxp3+ cells (cyan), and Th17, RORγT positive cells (green) [Vectra 3.0 spectral multiplex immunofluorescence (mIF) imaging system (PerkinElmer) and InForm 2.4.8 image analysis software Colors: Blue, DAPI; Red, CD3; Orange, CD8; Cyan, FOXP3; Yellow, TBet; Pink, GATA3; Green, RORγT].