Dados do Trabalho

Título

Hypersensitivity to acetylsalicylic acid (AAS) or primary cutaneous Th2 cell lymphoma? TO BE OR NOT BE?

Resumos

The importance of the anamnesis and physical examination protocol to carry out a differential diagnosis avoiding a wrong conduct with harm to the patient.
A 68 years old male referred for investigation of “allergy to aspirin”.
HCD: Sick for one year. After an AMI, started itchy skin rash. Treated with AAS and hypotensors.
PE: Erythroderma with positive glass slide sign, nail dystrophy and hyperchromic lesion infiltrated in the dorsal region.
1) hypersensitivity to AAS? 2) primary cutaneous T cell lymphoma. Requested: biopsy of the dorsal lesion. Lymphocyte subsets.
Results: PCR: 1,38. CD8: 31,8% (13,8 a 27,4) 534mm3(330 a 1008mm3). CD4: 39% (31a56%) 659mm3 (507 a 1496). CD3: 81,2 % (55,5 a 75,2) 1681mm3 (1350 a 2750). CD56: 6,3% (7a 22). CD16: 125% (137 a 567). Results: serial sections show dermis with dense infiltration of lymphocytes forming perivascular cuffs, interposing in the interstitium of collagen bundles and blurring the epidermis. The findings are consistent with a Perivascular and Interstitial Mycosis Fungoides. Solicitation: Immunohistochemistry, Sézary cells. Results: CD3/CD4/CD5/CD20/ CD45RA/ CD45RO diffuse positivity in perivascular lymphocytes and basal layer-aligned lymphocytes. CD7: positive in 40% of cells CD3-labeled, CD8: Multifocal positivity in perivascular lymphocytes, negative in basal layer-aligned lymphocytes. CD30: sparse cells permeate the infiltrate. Ki-67, p53: positive in about 10% of cells. Sezary cells: negative. Therapy: photochemotherapy. PUVA (Psoralen Ultra Violet A). Conclusions: The importance of the humanistic doctor-patient relationship, careful anamnesis and detailed physical examination is evidenced, although the history of the current disease is indicative of a more prevalent pathological state, so the realization of differential diagnoses should be observed.