2018 Volume 1 Issue 3 Pages 200-206
An 89-year-old woman presented with fever, labial mucosal erosion and erythema on the trunk and extremities. The erythema was round and exudative. The patient had had a common cold before the symptoms appeared and Herpes simplex virus antigen was positive for the labial mucosa. The drug-induced lymphocyte stimulation test (DLST) was also positive for multiple medicines. Erythema exsudativum multiforme (EEM) due to HSV and/or a drug was suspected. The rash disappeared quickly after steroid pulse therapy followed by oral predonisolone (PSL) 40 mg/day. PSL was slowly tapered to 10 mg/day over several weeks when the rash recurred. A computed tomography scan demonstrated systemic lymphadenopathies. A skin biopsy test from the thigh revealed vacuolar alteration and a dense perivascular lymphocytic infiltrate in the dermis. An inguinal lymph node biopsy showed dense atypical lymphocytic infiltrate and a diagnosis of angioimmunoblastic T-cell lymphoma (AITL) was made after immunostaining. AITL should be included as one of the differential diagnoses when the clinical course of the case is not typical for EEM.
