Abstract

INTRODUCTION CD30 positive lymphomatoid angiocentric drug reaction is characterised by perivascular atypical transformed T cells expressing CD30 in the setting of drug therapy. Cutaneous side effects from intravenous IgG (IVIG) are rare and include urticaria, erythema multiforme, other lichenoid reactions, morbiliform eruption, eczema, alopecia and vasculitis. CASE DESCRIPTION We describe the case of a 58 year old female who developed widespread small erythematous papules on the trunk and proximal limbs associated with subsequent IVIG which settled between infusions. She had multiple myeloma that was managed with weekly chemotherapy regimen comprising bortezomib and lenaliomide. Her other medications included trimethoprim/sulfamethoxazole, valaciclovir and dexamethasone. Her skin biopsy showed mild spongiosis and a superficial perivascular mixed inflammatory cell infiltrate comprising lymphocytes, histiocytes and eosinophils. There were focal aggregates of immunoblast-like cells that were positive for CD30, CD2, CD3 and CD5, and were negative for CD20 and ALK. This resembles type A lymphomatoid papulosis but is consistent with a CD30 positive lymphomatoid angiocentric drug reaction in this case. DISCUSSION The exact mechanism for this type IV hypersensitivity reaction is uncertain. Although IVIG are anti-inflammatory, under certain circumstances, this may act as antigens. In addition, multiple drug therapy is associated with immunological dysregulation and systemic immune dysfunction from a haematological malignancy may act synergistically or cumulatively to alter lymphocyte function. This may lead to perivascular aggregates of activated CD30 positive T cells that can be seen in hypersensitivity reactions. CONCLUSION CD30 positive lymphomatoid angiocentric drug reactions resembles lymphomatoid papulosis and the diagnosis rests upon clinicopathological correlation.

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