Drug reaction lymphocytic T88.7

Solitary or multiple pseudolymphoma as an adverse drug reaction.

Localized or generalized, usually less symptomatic (itching is in most cases completely absent) red or brown papules, plaques or nodules with mostly smooth surface. Extensive exanthema up to erythrodermia are possible. In individual cases arthralgia, hepatomegaly, splenomegaly, lymphadenopathy, leucocytosis.

2 different patterns with mostly monomorphic, mature cell lymphocyte infiltrates (mainly T-lymphocytes) are detectable.

• On the one hand diffuse or nodular patterns with dense lymphocytic infiltrates and hardly any other associated inflammatory cells.
• Otherwise lichenoid pattern with band-shaped, epidermotropic, lymphocytic infiltrates. In this case, the distinction from mycosis fungoides is not always easy to make.

Immunophenotypically, most lymphocytic drug reactions show a T-cell type. A B-cell pattern is not excluded.

Clinical:

• B-cell/T-cell lymphomas:The differentiation to B-cell and T-cell lymphomas is important and must be done histologically.
• Lichen planus: Has a hermaphroditic position, because the lichen planus can also be triggered by drugs. In this respect the clinical diagnosis "Lichen planus" is sufficient for the possible (relatively soon newly prescribed drugs should be discontinued - or implemented)
• Lymphadenosis cutis benigna: mostly solitary well definable lump; mainly in children and younger adults.
• Lymphomatoid contact dermatitis: chronic dermatitis which should have a clinical relation to the triggering contact mechanism. Triggering allergens (nickel, paraphenyldiamine).

Histological:

• T-cell lymphoma of the mycosis fungoides type: usually stronger epidermotropism with Pautrier microabscesses
• Lichen planus: here there are flowing transitions, since a "typical Llchen planus" can also be initiated by medication.
• T-cell-rich B-cell lymphoma: Clear, inorganic cell and nuclear polymorphism with high proliferation

S.a. Lymphomatoid contact dermatitis.

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