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Granulomatous CD30+ T-cell pseudolymphoma: case report A 55-year-old man developed granulomatous T-cell pseudolymphoma while receiving amlodipine for hypertension and azathioprine, ciclosporin and methotrexate for endogenous dyshidrotic hand eczema [dosages and routes not stated]. The man was hospitalized with six months history of asymptomatic eruption of erythematous firm papulonodules and annular infiltrated plaques on his neck, and symmetrically over the upper trunk, forearms, distal thighs and knees. Two weeks prior to the onset of rash, he started receiving amlodipine for hypertension. He also had a 5-year history of endogenous dyshidrotic hand eczema, which was treated with prednisolone and systemic immunosuppressants including azathioprine for 3 months, ciclosporin for 16 months and methotrexate. One month after starting, methotrexate was stopped due to lymphopaenia. He also had history of hypocortisolism secondary to exogenous corticosteroids. He also had received amlodipine 5 mg/day from 2013 to 2016. At admission, lab tests showed absolute eosinophil count of 12 800 /µL and immunoglobulin-E level of 31 545 IU/mL. Skin biopsy showed dermal oedema with a perivascular and interstitial infiltrate of lymphocytes, multinucleated giant cells, epithelioid histiocytes and nonpalisading polymorphs intermingled with numerous eosinophils. The infiltrate was predominantly in the superficial to mid-dermal layers. Immunophenotyping showed predominantly CD2-, CD3-, CD4- and CD5-positive infiltrate with focal loss of CD7- and occasional CD30-positive-T cells. Flow cytometry of the peripheral blood also showed increased CD4:CD8 ratio and loss of CD7 and CD26 expression. Peripheral blood T-cell receptor gene rearrangement analysis showed a monoclonal Tcell population with the gamma chain. He was diagnosed with amlodipine-associated reversible granulomatous T-cell pseudolymphoma. Amlodipine was discontinued. The man was treated with prednisolone. Two months later, his infiltrated dermal lesions had resolved with fall in peripheral eosinophilia. Six months later, no recurrence of rash was noted with eosinophil count of 640 /µL Cheong KW, et al. An instructive case of amlodipine-induced reversible granulomatous CD30+ T-cell pseudolymphoma. Australasian Journal of Dermatology 61: e346-e350, 803505219 No. 3, Aug 2020. Available from: URL: http://doi.org/10.1111/ajd.13240

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