Allergy Asthma Respir Dis.  2013 Dec;1(4):400-404. 10.4168/aard.2013.1.4.400.

Dapsone-induced drug reaction with eosinophilia and systemic symptoms syndrome, misdiagnosed as lymphoma

• Shin B
• Park SY
• Yoon SY
• Shin EH
• Yang YJ
• Cho HJ
• Jang IY
• Kang DU
• Kim TB
• Cho YS
• Moon HB
• Kwon HS

• KMID: 2262602
• DOI: http://doi.org/10.4168/aard.2013.1.4.400

Abstract

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lymphoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions recurred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syndrome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome.

Keyword

DRESS syndrome; Dapsone; Pseudolymphoma; Drug hypersensitivity

MeSH Terms

Biopsy
Dapsone
Diagnosis, Differential
Drug Hypersensitivity
Drug Hypersensitivity Syndrome*
Drug Therapy
Drug-Related Side Effects and Adverse Reactions
Eosinophilia
Exanthema
Fever
Humans
Leprosy
Liver
Lymph Nodes
Lymphatic Diseases
Lymphoma
Lymphoma, T-Cell, Peripheral
Prurigo
Pseudolymphoma
Skin
Dapsone

Figure

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  Fig. 1 Diffuse exfoliative erythroderma and maculopapular rash on patient's abdomen (A) and both arms (B).

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  Fig. 2 Histopathologic findings of neck lymph node biopsy (right level 1b). Lymph node biopsy showed a high proliferative activity, immunohistochemistry results suggestive of peripheral T-cell lymphoma. Diffuse polymorphic lymphoid hyperplasia with effacement of the normal lymphoid follicle architecture: (A) H&E, ×40; (B) H&E, ×400; (C) CD3, positive; (D) CD4, positive; (E) CD7, negative; (F) CD8, negative; (G) Ki-67, labeling index 70%; (H) TIA-1, negative.

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  Fig. 3 Biopsy of back skin with recurred skin eruption at second admission. Histological examination of the skin showed lymphocytic infiltration in the epidermis, and perivascular lymphocytic infiltration in the dermis. Epidermotropism is not identified (A, B: H&E, ×400). Similar immunohistochemistry findings with lymph node was observed (C: CD3, positive; D: CD4, positive; E: CD7, negative; F: Ki-67, 80%).

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  Fig. 4 Pictures of recurred skin eruption at second admission. Diffuse exfoliative erythroderma and maculopapular rash on patient's hands (A, B), abdomen (C), and back (D).

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  Fig. 5 Biopsy of wrist skin with recurred skin eruption at second admission. Histological examination of the skin revealed spongiosis and basal vacuolar degeneration with perivascular lymphocytic infiltration, consistent with a drug-associated eruption (A, B: H&E, ×400).

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