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The costimulatory receptor OX40 (CD134) is a member of the tumor necrosis factor receptor superfamily (TNFRSF), which is expressed on activated CD4+ and CD8+ T cells, neutrophils, and natural killer (NK) cells.23 OX40 has relevant costimulatory functions in the activation, survival and expansion of CD4+ and CD8+ T cells, and its binding with the ligand (OX40L) makes them less responsive to inhibitory signals from Tregs.23 In DRESS, peripheral blood mononuclear cells (PBMCs) also express OX40L, and the percentage of CD4+ T cells expressing OX40 correlates with the pattern of Th2-mediated immune responses.25 Patients with DRESS, in the acute phase of the reaction, show an increase in the number of Tregs and the total CD4+ T cells in the blood, when compared to healthy controls, which is not observed in TEN or other maculopapular drug eruptions
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