Images (1)
Drug reaction lymphocyticT88.7
Synonym(s)
Drug reaction; lymphocytic drug response; lymphomatoid drug reaction; lymphomatoid drug response; lymphomatoids; Pseudolymphoma
DefinitionThis section has been translated automatically.
Solitary or multiple pseudolymphoma as an adverse drug reaction.
EtiopathogenesisThis section has been translated automatically.
| Drugs that can trigger pseudolymphomas (modified according to Flaig and Sander) | |
| Substance group | Pharmaceuticals |
| Cardiac | Antiarrhythmics: Mexiletin |
| Ca-antagonists: Diltiazem, Verapamil | |
| ACE inhibitors: Captopril, Enalapril | |
| Neurologicals/Psychotropic drugs | Antidepressants: Amitriptyline, Doxepin, Fluoxetine, Lithium |
| Antiepileptic drugs: carbamazepine, phenobarbital, phenytoin, primidone | |
| Neuroleptics: Chlorpromazine, Prometazine, Thioridazine | |
| Tranquilizers: Clonazepam, Diazepam, Lorazepam | |
| Antibiotics | Penicillin |
| Antirheumatic drugs | Gold preparations, penicillamine |
| beta-receptor blockers | Atenolol |
| Cytostatics/immunosuppressive drugs | Ciclosporin A, methotrexate |
| H2-Blocker | cimetidine, ranitidine |
| Diuretics/Uricostatics | hydrochlorothiazide/allopurinol |
| Chemotherapeutics | dapsone, nitrofurantoin |
Clinical featuresThis section has been translated automatically.
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.
HistologyThis section has been translated automatically.
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.
Differential diagnosisThis section has been translated automatically.
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
Note(s)This section has been translated automatically.
S.a. Lymphomatoid contact dermatitis.
LiteratureThis section has been translated automatically.
- Choi TS et al (2003) Clinicopathological and genotypic aspects of anticonvulsant-induced pseudolymphoma syndrome. Br J Dermatol 148: 730-736
- Cogrel O (2001) Sodium valproate-induced cutaneous pseudolymphoma followed by recurrence with carbamazepine. Br J Dermatol 144: 1235-1238
- Flaig MJ, Sander CA (2003) Pseudolymphomas. In: Kerl H et al (Ed.) Histopathology of the skin. Springer Publishing House, Berlin Heidelberg New York, S. 855-868
- Geduk A et al(2015) Late-onset Anticonvulsant Hypersensitivity Syndrome Mimicking Lymphoma. Internal Med 54:3201-3204
- Inoue A et al (2015) CD30-positive Cutaneous Pseudolymphoma Caused by Tocilizumab in a Patient with Rheumatoid Arthritis: Case Report and Literature Review. Acta Derm Venereol doi: 10.2340/00015555-2309
- Kim KJ et al (2002) CD30-positive T-cell-rich pseudolymphoma induced by gold acupuncture. Br J Dermatol 146: 882-884
- Marucci G (2001) Gemcitabine-associated CD8+ CD30+ pseudolymphoma. Br J Dermatol 145: 650-652
- Ploysangam T et al (1998) Cutaneous pseudolymphomas. J Am Acad Dermatol 38: 877-895
- Riyaz N et al (2015) Phenytoin Induced Cutaneous B Cell Pseudolymphoma. Indian J Dermatol 60:522
- Saeki H et al (1999) Pseudolymphoma syndrome due to carbamazepine. J Dermatol 26: 329-331
- Apparent field N (2003) Phenytoin in cutaneous medicine: Its uses, mechanisms and side effects. Dermatol Online J 9: 6