T-cell lymphoma presenting as drug rash with eosinophilia and systemic symptoms syndrome
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is diagnosed by three criteria including cutaneous drug eruption, hematologic abnormalities, and systemic involvements. The hematologic abnormalities include presence of atypical lymphocytes or eosinophilia. The systemic involvements include lymphadenopathy, hepatitis, interstitial nephritis, interstitial pneumonia, or carditis. We experienced a 41-year-old female patient who presented DRESS syndrome at initial visit, but finally manifested with T-cell lymphoma. The patient complained of erythematous pruritic plaques with itching on her abdomen and thigh. There was no initiating factor and she was diagnosed with urticarial dermatitis. After treatment with antihistamine and systemic steroid, she recovered from skin lesion. However, 1 month later, she came to emergency department with aggravated skin lesion after taking nonsteroidal anti-inflammatory drug for 3 days. On admission, she showed a fever, skin rash, atypical lymphocytes in peripheral blood smear, and hepatitis. She was treated with systemic steroid under the impression of DRESS syndrome. Her symptoms began to improve, however, laboratory parameters were aggravated again. We performed bone-marrow biopsy because of her unusual progress. Finally she diagnosed with peripheral T-cell lymphoma and treated with allo-peripheral blood stem cell transplantation. In conclusion, we report a case of T-cell lymphoma which presented as DRESS syndrome. If patients with DRESS syndrome present lymphadenopathy and atypical lymphocytes, and do not respond to anti-inflammatory treatment, we should consider underlying lymphoproliferative disease.
Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is diagnosed by three criteria including cutaneous drug eruption, hematologic abnormalities, and systemic involvements. The hematologic abnormalities include presence of atypical lymphocytes or eosinophilia. The systemic involvements include lymphadenopathy, hepatitis, interstitial nephritis, interstitial pneumonia, or carditis. We experienced a 41-year-old female patient who presented DRESS syndrome at initial visit, but finally manifested with T-cell lymphoma. The patient complained of erythematous pruritic plaques with itching on her abdomen and thigh. There was no initiating factor and she was diagnosed with urticarial dermatitis. After treatment with antihistamine and systemic steroid, she recovered from skin lesion. However, 1 month later, she came to emergency department with aggravated skin lesion after taking nonsteroidal anti-inflammatory drug for 3 days. On admission, she showed a fever, skin rash, atypical lymphocytes in peripheral blood smear, and hepatitis. She was treated with systemic steroid under the impression of DRESS syndrome. Her symptoms began to improve, however, laboratory parameters were aggravated again. We performed bone-marrow biopsy because of her unusual progress. Finally she diagnosed with peripheral T-cell lymphoma and treated with allo-peripheral blood stem cell transplantation. In conclusion, we report a case of T-cell lymphoma which presented as DRESS syndrome. If patients with DRESS syndrome present lymphadenopathy and atypical lymphocytes, and do not respond to anti-inflammatory treatment, we should consider underlying lymphoproliferative disease.
참고문헌 (13)
- Bigby M, "Drug-induced cutaneous reactions: a report from the Boston Collaborative Drug Surveillance Program on 15,438 consecutive inpatients, 1975 to 1982", JAMA, 256, pp.3358~3363 (1986)
- Turk BG, "Adverse cutaneous drug reactions among hospitalized patients: five year surveillance", Cutan Ocul Toxicol, 32, pp.41~45 (2013)
- Roujeau JC, "Severe adverse cutaneous reactions to drugs", N Engl J Med, 331, pp.1272~1285 (1994)
- Roujeau JC, "Clinical heterogeneity of drug hypersensitivity", Toxicology, 209, pp.123~129 (2005)
- 안소연, "Vancomycin-Associated Spontaneous Cutaneous Adverse Drug Reactions", Allergy, Asthma & Immunology Research, 3(3), pp.194~198 (2011), 대한천식알레르기학회
- Bocquet H, "Drug-induced pseudolymphoma and drug hypersensitivity syndrome (Drug Rash with Eosinophilia and Systemic Symptoms: DRESS)", Semin Cutan Med Surg, 15, pp.250~257 (1996)
- Saltzstein SL, "Lymphadenopathy induced by anticonvulsant drugs and mimicking clinically pathologically malignant lymphomas", Cancer, 12, pp.164~182 (1959)
- 임민영, "Cervical Lymphadenopathy Mimicking Angioimmunoblastic T-Cell Lymphoma after Dapsone-Induced Hypersensitivity Syndrome", Journal of Pathology and Translational Medicine, 46(6), pp.606~610 (2012), 대한병리학회
- Cacoub P, "The DRESS syndrome: a literature review", Am J Med, 124, pp.588~597 (2011)
- Kano Y, "The variable clinical picture of drug-induced hypersensitivity syndrome", drug rash with eosinophilia and systemic symptoms in relation to the eliciting drug, 2009, pp.29, 481~501
- 이병재, "Comparison of the Causes and Clinical Features of Drug Rash With Eosinophilia and Systemic Symptoms and Stevens-Johnson Syndrome", Allergy, Asthma & Immunology Research, 2(2), pp.123~126 (2010), 대한천식알레르기학회
- Chan JK, "Common misdiagnoses in lymphomas and avoidance strategies", Lancet Oncol, 11, pp.579~588 (2010)
- Ogawa K, "Identification of thymus and activation-regulated chemokine (TARC", CCL17) as a potential marker for early indication of disease and prediction of disease activity in drug-induced hypersensitivity syndrome (DIHS), J Dermatol Sci, pp.2013, 69[DOI]