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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.

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