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Two Different Clinical Entities

Valerie Callot, MD; Jean-Claude Roujeau, MD; Martine Bagot, MD; Janine Wechsler, MD; Olivier Chosidow, MD; Pierre Souteyrand, MD; Patrice Morel, MD; Louis Dubertret, MD; Marie-Françoise Avril, MD; Jean Revuz, MD

Arch Dermatol. 1996;132(11):1315-1321.

Abstract
Objective
To test the hypothesis that drug-induced pseudolymphoma and hypersensitivity syndrome are 2 distinct clinical entities.

Design
Retrospective study from 1980 to 1993.

Setting
Departments of dermatology and medicine of 5 referral universitary hospitals.

Patients
Twenty-four patients who met arbitrary criteria selected as being suggestive of lymphoma, with probable drug cause. Patients with other definite cutaneous drug-induced eruptions were excluded.

Intervention
None.

Main Outcome Measures
Suspect drugs; clinical, biological, and pathological findings; and evolution of each case and of 110 published case reports.

Results
Two groups were separated according to their mode of onset and clinical aspect. Three patients (and 15 cases in the literature) had subacute papulonodular or infiltrated plaques, without visceral involvment. Skin biopsy specimens showed a dense lymphocytic infiltrate mimicking lymphoma. Healing was constant when the drug was stopped. The 21 remaining patients (and 95 published cases) had an acute widespread eruption, with fever, enlarged lymph nodes, and multivisceral involvement. Lymphocytosis, atypical lymphocytes, eosinophilia, hepatitis, and high levels of lactate dehydrogenase were frequent. Skin biopsy findings were usually not specific (lymphocytic infiltrate and keratinocyte necrosis) but sometimes mimicked lymphoma. Severe forms and relapses occurred, even after the drug was stopped. The inducing drugs were the same in the 2 groups.

Conclusions
These 2 groups correspond to drug-induced pseudolymphoma and hypersensitivity syndrome. We think that they are 2 distinct entities with different clinical and biological features and outcome, even if the pathological findings are sometimes similar. Prospective studies are needed to confirm these facts, to evaluate the therapy, and to follow up patients.

Arch Dermatol. 1996;132:1315-1321

Author Affiliations
From the Departments of Dermatology (Drs Callot, Roujeau, Bagot, and Revuz) and Pathology (Dr Wechsler), Hôpital Henri Mondor, Creteil, France; Department of Internal Medicine, Groupe Hospitalier Pitié-Salpétrière, Paris, France (Dr Chosidow); Department of Dermatology, Hôtel Dieu, Clermont-Ferrand, France (Dr Souteyrand); Department of Dermatology, Hôpital Saint Louis, Paris (Drs Morel and Dubertret); and Department of Dermatology, Institut Gustave Roussy, Villejuif, France (Dr Avril).

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