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￭ S-673 ￭
Erythema multiforme associated with herpes zoster in a pregnant woman
Ulsan University Hospital
*So Young Lee, Doo-Ho Lim, Seung Won Choi
Introduction: Erythema multiforme (EM) is an acute skin condition characterized by the appearance of distinctive target-like lesions. EM is consid- ered to be hypersensitivity reaction associated with drugs or infections. Varicellar zoster virus (VZV), the pathogen of herpes zoster (HZ), is thought to be rare etiology of EM. Moreover, the EM associated with HZ usually happened after acyclovir use and has rarely been reported in pregnant woman.
Here, we report a pregnant woman of the EM associated HZ after famciclovir treatment. Case: A 24-year old woman was admitted to our hospital with a multiform, partly vesiculous exanthematous rash on her whole body, developed 5 days ago (Figure 1-A). She was 22 weeks and five days pregnant.
She had a history of HZ on C7 dermatome of left upper back 21 days ago and treated with famciclovir for 5 days. She had no other comorbidity or medications. Laboratory results did not identify any significant abnormalities. We took a skin biopsy that showed intercellular edema, hydropic degen- eration of basal keratinocytes and perivascular lymphocytic and eosinophilic infiltration in the papillary dermis, suggesting EM (Figure 1-B). With chlorpheniramine (2mg, three times a day, for 7 days) and topical corticosteroid, EM completely resolved within one month. Conclusions: VZV in- fections are rare triggering factor of EM. HZ associated EM in a pregnant woman has not been reported so far. This case is reported for its rare associa- tion of EM and HZ and also for its rare manifestation in a pregnant woman.
￭ S-674 ￭
Anaplastic large cell lymphoma with marked peripheral eosinophilia misconcepted as Kimura's disease
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
*Yoon Ji Shin, Jee Youn Oh, Young Seok Lee, Kyung Hoon Min, Sung Yong Lee, Jae Jeong Shim, Kyung Ho Kang, and Gyu Young Hur
Background: Hypereosinophilia, defined as an absolute eosinophil count (AEC) of ＞1.5×103/L can be caused by numerous allergic, infectious, para- neoplastic and neoplastic disorders. In case of hypereosinophilia with lymphoid proliferation, pathologic confirmation is essential to exclude myeloid and lymphoid malignancy. Kimura's disease, common in Asians, is idiopathic, chronic inflammatory disease with painless subcutaneous mass and prominent peripheral eosinophilia. We report a case of anaplastic large cell lymphoma, with initial presentation of marked peripheral eosinophilia, mis- concepted as Kimura's disease. Case: A 38-year-old woman presented with bilateral cervical lymphadenopathy. She underwent core biopsy and was di- agnosed as Kimura's disease at local clinic. She was referred to our hospital for evaluation and management of peripheral eosinophilia. At admission, there was no palpable cervical lymph node. Blood test showed hypereosinophilia (8,450/μL) with high total IgE level (＞5,000 kU/L). All laboratory tests for parasite infestation were negative. Bone marrow biopsy only revealed hypercellular marrow without evidence of a lymphoproliferative dis- order, and negative for screening of JAK2V617F,BCR-ABL1, PDGFRA and PDGFRB rearrangement. She received treatment for Kimura’s disease with prednisone and immunosuppressants, however, her AEC was wax and wane (from 495 to 1,720/μL) during 5 months. A new left inguinal mass was developed, and we performed excisional lymph node biopsy. Histopathological examination showed infiltration of large atypical lymphoid cells with numerous eosinophils. They were CD3＋,CD20-,CD30＋ and ALK- by immunohistochemistry. ALK-negative anaplastic large cell lymphoma was diagnosed. Careful review of the initial cervical lymph node biopsy showed only lymphoid proliferation with heavy eosinophils in H/E stain. However, after immunohistochemical study, there were a few irregular cells with CD30＋. Conclusions: Marked peripheral eosinophilia in anaplastic large cell lymphoma observed in our case has been rarely reported. This emphasizes that immunohistochemical study should be performed to exclude myeloid and lymphoid malignancy in diagnosis of Kimura's disease.
