title: CD30 Positive Lymphomatoid Angiocentric Drug Reactions: Characterization of a Series of 20 Cases.
abstract: BACKGROUND
  Lymphomatoid drug reactions are atypical T cell cutaneous lymphocytic infiltrates induced by pharmacological therapy. Due to phenotypic abnormalities, clonality, and their close clinical and morphologic resemblance to T cell lymphomas, these eruptions have been categorized as drug-associated reversible granulomatous T cell dyscrasias.
  
  
  METHODS
  A total of 20 cases were encountered in which a diagnosis of CD30 lymphomatoid drug reaction was rendered.
  
  
  RESULTS
  There were 11 women and 9 men ranging from 31 to 86 years of age presenting with a sudden onset often generalized cutaneous papular eruption. Two patients had vasculitic lesions. In all cases, a positive drug history was elicited and in most the initiation of the drug was temporally associated with the cutaneous eruption. Among the implicated drugs were statins (6 cases), immunomodulators (4 cases), ACE inhibitors (3 cases), antibiotics (3 cases), chemotherapy agents (3 cases), and antidepressants (1 case). Biopsies demonstrated a similar morphology, namely a superficial angiocentric lymphocytic infiltrate containing many immunoblasts. Tissue eosinophilia, interface dermatitis, and supervening eczematous changes in the overlying epidermis were observed in most cases. In all cases, the angiocentric infiltrate was highlighted by CD3, CD30, and CD4. Cytotoxic protein granule expression or monoclonality was not observed. In all cases, there was improvement or complete regression of the eruption upon drug modulation.
  
  
  CONCLUSIONS
  The CD30 positive lymphomatoid angiocentric drug reaction poses a diagnostic challenge because of its close resemblance to type A lymphomatoid papulosis and potential confusion with a peripheral T cell lymphoma with large cell transformation.
authors.affiliation: *Department of Pathology and Laboratory Medicine, New York Presbyterian Hospital-Weill Cornell Medicine, New York, NY; †Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO; and ‡Department of Dermatology, University of California at Irvine, Orange, CA.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Magro
authors.forename: Luke C
authors.initials: LC
authors.lastname: Olson
authors.forename: Giang Huong
authors.initials: GH
authors.lastname: Nguyen
authors.forename: Sebastien M
authors.initials: SM
authors.lastname: de Feraudy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D003875:Drug Eruptions / Q000175:diagnosis* / Q000473:pathology*; D005260:Female; D006801:Humans; D017730:Ki-1 Antigen / Q000032:analysis*; D017731:Lymphomatoid Papulosis / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012878:Skin Neoplasms / Q000175:diagnosis
chemical_list: D014408:Biomarkers, Tumor; D017730:Ki-1 Antigen