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Cefuroxime induced lymphomatoid hypersensitivity reaction.
Postgraduate Medical Journal
|August 30, 2000
Summary
A rare drug reaction caused an elderly woman to develop a rash resembling cutaneous T cell lymphoma after starting cefuroxime. The reaction resolved after stopping the antibiotic, highlighting drug-induced immune responses.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Drug-induced cutaneous reactions can mimic hematologic malignancies.
- Cutaneous T cell lymphoma (CTCL) is a diverse group of conditions with varied presentations.
- Antibiotics, including cephalosporins like cefuroxime, are known triggers for adverse skin reactions.
Observation:
- An 84-year-old woman presented with erythematous, blotchy, and purpuric rashes on her lower limbs.
- The onset of the rash occurred three days after initiating intravenous cefuroxime for acute diverticulitis.
- Skin biopsy revealed a mixed lymphoid and eosinophilic infiltrate, with large, pleomorphic, CD30-positive T cells.
Findings:
- The atypical lymphoid infiltrate showed T cell enrichment and CD30 positivity, mimicking CTCL but lacking definitive features like epidermotropism or Pautrier's abscesses.
- The patient's rash resolved completely within 10 days of discontinuing cefuroxime.
- The patient remained asymptomatic for 15 months post-cessation, suggesting a drug-induced phenomenon.
Implications:
- This case highlights a lymphomatoid vascular reaction, a drug-induced immune response that can mimic cutaneous pseudolymphoma or CTCL.
- Accurate diagnosis is crucial to differentiate drug reactions from true lymphomas, guiding appropriate management and avoiding unnecessary treatments.
- Awareness of such atypical drug reactions is important for clinicians managing patients on antibiotics, particularly the elderly.