Clinical Features:

• Patients often have an underlying disturbance of immune regulation, such as lymphoma, HIV or autoimmune disease.
• Presents as a solitary or multiple plaques, which may resemble mycosis fungoides, or nodules
• May be quite difficult to distinguish from lymphoma, and may evolve into true lymphoma
• The most commonly implicated drugs are:
  • ACE inhibitors
  • Alpha antagonists
  • Anticonvulsants
  • Antidepressants
  • Benzodiazepines
  • Beta blockers
  • Calcium channel blockers
  • Histamine antagonists
  • Lithium
  • Antihyperlipidemics
  • NSAIDs
  • Phenothiazines
  • Sex steroids

Histologic Features:

• Mycosis fungoides-like pattern:
  • Upper dermal infiltrate of mildly atypical T-cells
  • If epidermotropism is present, it is usually mild, tending to mainly affect the suprapapillary plates and adnexae.
  • Basal vacuolar alteration
  • Spongiosis to vesiculation
  • Necrotic keratinocytes
  • Papillary dermal edema
• Lymphomatoid vascular reaction pattern:
  • Perivascular and transmural infiltrates of mildly atypical lymphocytes that obscure the vessel architecture
  • Usually no fibrinoid necrosis of the vessel walls

Cases associated with this book:

Lymphomatoid drug reaction
Author: Stephen Lyle, M.D., Ph.D.

Conference: DermatopathologyConsultations.com Teaching Collection