Lymphomatoid drug reaction

    Article Contributors: 
    Sean Klepper M.D.
    Stephen Lyle, M.D., ...

    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: Teaching Collection